Amanda Roberts, QOM

Key facts

NPI

1154961100

Entity type

Individual (NPI type 1)

Primary specialty

Other Specialist/Technologist 246Z00000X

Practice address

113 County Line Rd
Tyner, NC 27980-9690

Phone

(252) 506-2522

NPI assigned

Jan 7, 2020

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 7, 2020.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1154961100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 COUNTY LINE RD",
            "city": "TYNER",
            "state": "NC",
            "postal_code": "279809690",
            "telephone_number": "252-506-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 COUNTY LINE RD",
            "city": "TYNER",
            "state": "NC",
            "postal_code": "279809690",
            "telephone_number": "252-506-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "QOM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Tyner, NC · Other Specialist/Technologist in North Carolina