Individual
LILLY IDA ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
322 DOGWOOD HOLLOW RD, MOUNTAIN VIEW, AR 72560-8626
(870) 269-2995
(870) 269-2991
Mailing address
PO BOX 1060, MARSHALL, AR 72650-1060
(870) 448-5733
(870) 448-5736
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A01186 ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54041B477
BLUECROSS OF ARKANSAS
AR
01
—
P000014273
RAILROAD MEDICARE
AR
Enumeration date
06/15/2005
Last updated
03/11/2020
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