Provider Demographics
NPI:1730468273
Name:ROBERTS, JAMES GREGORY JR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GREGORY
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-516-2180
Mailing Address - Fax:901-516-2077
Practice Address - Street 1:1265 UNION AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-516-2180
Practice Address - Fax:901-516-2077
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872659363LF0000X
TN16041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily