Tyrone G Roberson Sr., AGPCNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

19344 Issued in SC

Practice address

6439 Garners Ferry
Columbia, SC 29209

Phone

(803) 776-4000

NPI assigned

Mar 20, 2011

Sex

Male

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

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Vitality Healthcare Services LLC

  • Clinic/Center
  • Clinton, SC
  • NPI 1801568225
  NPD Authorized official

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

{
    "created_epoch": "1300579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1134428923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6439 GARNERS FERRY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29209",
            "telephone_number": "803-776-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6439 GARNERS FERRY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29209",
            "telephone_number": "803-776-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "TYRONE",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-20",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "SC",
            "license": "69630",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SC",
            "license": "PR27111",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "19344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Detris Lashall Roberson, APRN
• Jade E. Roberson, RBT
• Jo Ellen Roberson, RN
• Sabria Roberson
• Tawana Naydean Roberson, DC
• Uniqa Sade Roberson, RN
• Robert L. Waldron, II, MD, PA
• Robert M. Crooks, Jr., D.M.D.
• Aundreana Roberts, RBT
• Carla W Roberts, MD

• Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.