Provider Demographics
NPI:1770760563
Name:ROBERTS, LINDA JONES (APRN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JONES
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 N 1500 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4355
Mailing Address - Country:US
Mailing Address - Phone:435-753-4658
Mailing Address - Fax:
Practice Address - Street 1:2051 NORTH 600 WEST, CVYC
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4355
Practice Address - Country:US
Practice Address - Phone:435-770-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT219829-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily