Provider Demographics
NPI:1881267516
Name:ROBERTS, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 ALEXANDRIA JACKSONVLE HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-6345
Mailing Address - Country:US
Mailing Address - Phone:256-770-9801
Mailing Address - Fax:
Practice Address - Street 1:307 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1048
Practice Address - Country:US
Practice Address - Phone:205-939-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099901363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care