Provider Demographics
NPI:1477950830
Name:ROBERTS, CARLA MELTON (CRNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MELTON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:WILBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5120 STONEARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-6417
Mailing Address - Country:US
Mailing Address - Phone:228-369-0184
Mailing Address - Fax:
Practice Address - Street 1:3670 GRANDVIEW PKWY # 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:407-788-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily