Active NPI
Paulette Roberts, FNP
- Family Nurse Practitioner
- Springfield Gardens, NY
National Provider Identifier
1174918494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F339552-1
- Practice address
- 13749 Southgate St
Springfield Gardens, NY 11413-2628 - Phone
- (646) 644-3622
- NPI assigned
- Apr 2, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F339552-1 | NY | Primary |
Addresses
Primary practice location
13749 Southgate St
Springfield Gardens, NY 11413-2628
Mailing address
13749 Southgate St
Springfield Gardens, NY 11413-2628
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181024001137 | NY | Order and Referring Only - Nurse Practitioner | 7113270984 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 339552 | NY | MD | Licensed Practical Nurse |
| F339552-1 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1174918494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13749 SOUTHGATE ST",
"city": "SPRINGFIELD GARDENS",
"state": "NY",
"postal_code": "114132628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13749 SOUTHGATE ST",
"city": "SPRINGFIELD GARDENS",
"state": "NY",
"postal_code": "114132628",
"telephone_number": "646-644-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "PAULETTE",
"name_prefix": "Ms.",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-02",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "F339552-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield Gardens, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.