Individual provider Active NPI

Kristen Cassidy Roberts, FNP-C

  • Family Nurse Practitioner
  • Greenville, MS
National Provider Identifier
1023627122
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904036 Issued in MS
Practice address
1502 S Colorado St
Greenville, MS 38703-7219
Phone
(662) 355-4105
NPI assigned
Jul 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 904036 MS Primary

Addresses

Primary practice location

1502 S Colorado St
Greenville, MS 38703-7219

Mailing address

607 Holly Dr
Indianola, MS 38751-2525
Phone (662) 207-7035

Other practice location 1

840 N Oak Ave
Ruleville, MS 38771-3227
Phone (662) 756-4024

Other names 1

  • Kristen Cassidy Scott Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200814000255 MS Practitioner - Nurse Practitioner 6204252794 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delta Kidney Alliance LLCGroup PAC ID 3870834856, 4 clinicians

Practice addresses (Care Compare)

1502 S Colorado St
Greenville, MS 38703-7219
Phone (662) 335-4105

Hospital & facility affiliations

  • Delta Health System - the Medical Center Hospital, Greenville, MS, CCN 250082

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Sunflower Medical Center CurrentSince Jul 24, 2020 Accepting new patients
North Sunflower Medical Center CurrentSince Jul 24, 2020 Accepting new patients
North Sunflower Medical Center Current Accepting new patients
Northern Mississippi Vascular Access Center Past Accepting new patients

Locations

840 N Oak Ave
Ruleville, MS 38771
Phone (601) 756-2711

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1023627122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 HOLLY DR",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512525",
            "telephone_number": "662-207-7035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037219",
            "telephone_number": "662-355-4105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "840 N Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Ruleville",
            "state": "MS",
            "postal_code": "387713227",
            "country_code": "US",
            "telephone_number": "662-756-4024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRISTEN",
        "middle_name": "CASSIDY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-24",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "SCOTT",
            "middle_name": "CASSIDY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.