Provider Demographics
NPI:1508394180
Name:ROBERTS, SCOTT LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-2268
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:3900 S ZINTEL WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5092
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-585-8125
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60764788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner