Provider Demographics
NPI:1942488457
Name:ROBERTS, CYNTHIA E (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:F
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 1:4 RIVER RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7761
Mailing Address - Country:US
Mailing Address - Phone:816-344-4439
Mailing Address - Fax:
Practice Address - Street 1:4055 VALLEY VIEW LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5071
Practice Address - Country:US
Practice Address - Phone:877-570-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46148363LF0000X
MO112198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200601490AMedicaid
MOP00735197OtherRR MEDICARE
MO208332304Medicaid
KS200601490AMedicaid