Provider Demographics
NPI:1780829259
Name:DURK, ROBERTA ANN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:DURK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6102
Mailing Address - Country:US
Mailing Address - Phone:915-532-9000
Mailing Address - Fax:915-532-9006
Practice Address - Street 1:4500 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6102
Practice Address - Country:US
Practice Address - Phone:915-532-9000
Practice Address - Fax:915-532-9006
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601596363LF0000X, 363LP0200X
TX08620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201549708Medicaid