Provider Demographics
NPI:1225737505
Name:ROBERTS, ANDREA LYNN (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PALO ALTO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-8034
Mailing Address - Country:US
Mailing Address - Phone:910-546-1495
Mailing Address - Fax:
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-833-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017731363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care