Provider Demographics
NPI:1518243526
Name:ROBERTS, TERRI LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:L
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-1288
Mailing Address - Country:US
Mailing Address - Phone:318-648-0375
Mailing Address - Fax:
Practice Address - Street 1:431 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3463
Practice Address - Country:US
Practice Address - Phone:318-648-0375
Practice Address - Fax:318-648-0378
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO6303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2171313Medicaid
3C877DK22Medicare PIN