Individual
MS. MARY JACQUELINE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP
Contact information
Practice address
1465 N GARDNER ST, SCOTTSBURG, IN 47170-7751
(812) 752-0001
(812) 752-0010
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9408
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
3007173
KY
363LF0000X
Family Nurse Practitioner
Primary
71004757A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201050260
—
IN
05
—
7100186690
—
KY
01
—
71004757A
STATE LICENSE
IN
Enumeration date
10/10/2011
Last updated
02/26/2024
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