Provider Demographics
NPI:1487658431
Name:ROBERTS, LINDA BETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:BETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:BETH
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3100 N GLASSFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2285
Mailing Address - Country:US
Mailing Address - Phone:928-772-3336
Mailing Address - Fax:928-772-3363
Practice Address - Street 1:3100 N GLASSFORD HILL RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2285
Practice Address - Country:US
Practice Address - Phone:928-772-3336
Practice Address - Fax:928-772-3363
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP31875Medicare UPIN
AR5H5067343Medicare PIN