Provider Demographics
NPI:1841066420
Name:ROBERTS, COLLIN JAMES (PA)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:JAMES
Last Name:ROBERTS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:AR
Mailing Address - Zip Code:71826-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4065 HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:AR
Practice Address - Zip Code:71826-8701
Practice Address - Country:US
Practice Address - Phone:479-925-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2023-081363A00000X
ARPA-1227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant