Provider Demographics
NPI:1467739672
Name:ROBERTS, CHRISTY RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:RENEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6260
Mailing Address - Country:US
Mailing Address - Phone:936-639-1141
Mailing Address - Fax:
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698873363LF0000X
TXAP120872363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016SHOtherBCBS
TX2035487-02Medicaid
VAP01006556OtherPALMETTO RR
TX2870578-01Medicaid
TXD07564OtherPALMETTO RR
TX865N98OtherBCBS
TXTXB142204Medicare PIN
TXTXB102736Medicare PIN