Provider Demographics
NPI:1942228937
Name:ROBERTS, LAURA CAMERON (FNP-C, ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CAMERON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-C, ACNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAMERON
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, ACNP
Mailing Address - Street 1:2110 HOLLY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0947
Mailing Address - Country:US
Mailing Address - Phone:903-520-2454
Mailing Address - Fax:903-525-3448
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-525-3668
Practice Address - Fax:903-525-3448
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 681561363LC0200X
TX681561363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308897900Medicaid
FLY124WOtherBCBS
FLAI744ZMedicare PIN
TXQ34236Medicare UPIN