Provider Demographics
NPI:1255110771
Name:ROBERTS, MEREDITH LAINE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LAINE
Last Name:ROBERTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LAINE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:PO BOX 731263
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1263
Mailing Address - Country:US
Mailing Address - Phone:214-947-2385
Mailing Address - Fax:214-947-2390
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-2385
Practice Address - Fax:214-947-2390
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner