Individual
JACKQUELINE L ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
3080 COLLEGE ST, BEAUMONT, TX 77701-4606
(409) 212-5000
Mailing address
PO BOX 205, THICKET, TX 77374-0205
(520) 425-0739
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
690734
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
1172149
TX
363LG0600X
Gerontology Nurse Practitioner
1172149
TX
Other
Enumeration date
08/15/2024
Last updated
10/29/2024
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