# FANCY GAP INTERNAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Susan Tracy Roberts
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043049828
- **Authorized official:** MRS. SUSAN TRACY ROBERTS NP-C (OWNER)
- **Authorized official phone:** (276) 728-0735

## Contact information

- **Practice address:** 1661 TURNER SPUR RD, FANCY GAP, VA 24328-4365
- **Practice address phone:** (276) 728-0735
- **Practice address fax:** (866) 464-0644
- **Mailing address:** 1661 TURNER SPUR RD, FANCY GAP, VA 24328-4365
- **Mailing address phone:** (276) 728-0735
- **Mailing address fax:** (866) 464-0644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2024
- **Last updated:** 07/30/2024