Active NPI
Shane Roberts, RN
- Registered Nurse
- Las Cruces, NM
National Provider Identifier
1114503471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R48732
- Practice address
- 2630 Desert Dr
Las Cruces, NM 88001-1505 - Phone
- (501) 606-1701
- NPI assigned
- Mar 18, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R48732 | NM | Primary |
Addresses
Primary practice location
2630 Desert Dr
Las Cruces, NM 88001-1505
Mailing address
2630 Desert Dr
Las Cruces, NM 88001-1505
Phone (501) 606-1701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R48732 | NM | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616025600000",
"number": "1114503471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 DESERT DR",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011505",
"telephone_number": "501-606-1701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 DESERT DR",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011505",
"telephone_number": "501-606-1701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SHANE",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-03-18",
"last_updated": "2021-03-18",
"certification_date": "2021-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NM",
"license": "R48732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.