Provider Demographics
NPI:1669668422
Name:ROBERSON, STEVE R (APRN)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:R
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18261
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8261
Mailing Address - Country:US
Mailing Address - Phone:601-442-1900
Mailing Address - Fax:601-442-1908
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-442-1900
Practice Address - Fax:601-442-1908
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS$$$$$$$$$BOtherBLUE CROSS BLUE SHIELD