Emmie Lou Roberts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01167 Issued in RI

Practice address

209 Armistice Blvd
Pawtucket, RI 02860-3242

Phone

(401) 725-4100

NPI assigned

Jun 26, 2019

Last updated

Mar 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1083275325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 ARMISTICE BLVD",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028603242",
            "telephone_number": "401-725-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 ARMISTICE BLVD",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028603242",
            "telephone_number": "401-725-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "758 Eddy St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034940",
            "country_code": "US",
            "telephone_number": "401-236-7258",
            "fax_number": "774-465-0469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "EMMIE LOU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA01167",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01167",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7338",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayra Madely Rivera, LMT
• Riverside Community Care
• Suellen Rizzo, LCSW
• Rachel Alison Roach, NP
• Robert J. Fortuna, MD,LTD
• Julie A Roberts
• Lynn Ann Robin, RDH
• Derrick M Robinson, PHYSICIAN ASSISTANT
• Kaitlyn Robinson
• Marcia Robitaille, MD

• Physician Assistant in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.