Provider Demographics
NPI:1477093557
Name:ROBERTS, LAUREN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3325
Mailing Address - Country:US
Mailing Address - Phone:580-245-7004
Mailing Address - Fax:866-531-9981
Practice Address - Street 1:515 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3325
Practice Address - Country:US
Practice Address - Phone:580-245-7004
Practice Address - Fax:866-531-9981
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0132066363LF0000X
ARA005084364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0132066OtherNURSING BOARD
ARA005084OtherCNP LICENSE