Jeri Dawn Fallin-Roberts, CNA, MEDICATION ADMI

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

CNA122786 Issued in FL

Practice address

5934 Pitti LN
Youngstown, FL 32466-1949

Phone

(850) 257-1429

NPI assigned

Nov 1, 2022

Last updated

Nov 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1144937830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261",
            "city": "YOUNGSTOWN",
            "state": "FL",
            "postal_code": "324660261",
            "telephone_number": "850-624-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5934 PITTI LN",
            "city": "YOUNGSTOWN",
            "state": "FL",
            "postal_code": "324661949",
            "telephone_number": "850-257-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLIN-ROBERTS",
        "first_name": "JERI",
        "middle_name": "DAWN",
        "credential": "CNA, MEDICATION ADMI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-01",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse's Aide",
            "state": "FL",
            "license": "CNA122786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED NURSING ASSISTANT LICENSE NUMBER",
            "identifier": "CNA122786",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "fallin@bridgepointcommunitycare.co",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client Information",
            "address_1": "5934 Pitti Ln",
            "city": "Youngstown",
            "state": "FL",
            "country_code": "US",
            "postal_code": "324661949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nurse's Aide in Youngstown, FL
• Providers in Youngstown, FL by specialty
• Nurse's Aide in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.