Individual
MRS. GWENITA ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3436 S POLK ST, DALLAS, TX 75224-3804
(214) 372-9200
(214) 372-9201
Mailing address
3436 S POLK ST, DALLAS, TX 75224-3804
(214) 372-9200
(214) 372-9201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
578285
TX
363LF0000X
Family Nurse Practitioner
578285
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10008701
—
TX
05
—
12906
—
TX
05
—
155741501
—
TX
05
—
155741502
—
TX
05
—
155741503
—
TX
01
—
562313709
UNITED HEALTHCARE
TX
01
—
7149594
AETNA
TX
01
—
8Y1837
BLUE CROSS BLUE SHIELD
TX
01
—
NP7128
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/13/2006
Last updated
10/24/2022
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