Individual
JACQUELYN ELAINE ROBERTS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
115 31ST AVE SE, MOULTRIE, GA 31768-6771
(229) 890-1665
(229) 985-5050
Mailing address
115 31ST AVE SE, MOULTRIE, GA 31768-6771
(229) 890-1665
(229) 985-5050
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
RN128424
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00829617C
—
GA
Enumeration date
09/09/2005
Last updated
07/08/2007
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