Provider Demographics
NPI:1659870590
Name:ROBERTS, MADONNA MARIE (RN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, AGACNP-BC
Other - Prefix:
Other - First Name:MADONNA
Other - Middle Name:MARIE
Other - Last Name:DUPRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:232 IRICK CT
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1213
Mailing Address - Country:US
Mailing Address - Phone:214-676-7068
Mailing Address - Fax:
Practice Address - Street 1:4400 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1892
Practice Address - Country:US
Practice Address - Phone:469-322-7481
Practice Address - Fax:469-322-7807
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718016163WC0200X
TXAP135379363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine