Individual provider Active NPI

Nancy Lynn Robertson, APRN

  • Family Nurse Practitioner
  • De Witt, IA
National Provider Identifier
1265104707
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A165449 Issued in IA
Practice address
2422 12TH Street CT
De Witt, IA 52742-1225
Phone
(563) 659-6090
NPI assigned
Oct 4, 2021
Last updated
Jan 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A165449 IA Primary

Addresses

Primary practice location

2422 12TH Street CT
De Witt, IA 52742-1225

Mailing address

2422 12TH Street CT
De Witt, IA 52742-1225
Phone (563) 659-6090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211217000558 IA Practitioner - Nurse Practitioner 1658762109 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dewitt Family Practice PLLCGroup PAC ID 1850738592, 5 clinicians

Practice addresses (Care Compare)

1415 11TH St
Suite C
De Witt, IA 52742-1292
Phone (563) 659-6090

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation CurrentSince Dec 1, 2021 Accepting new patients
Dewitt Family Practice, PLLC CurrentSince Dec 2, 2024 Accepting new patients
Laboratory Corporation of America Holdings PastSince Jan 26, 2025 Accepting new patients
Trinity Medical Center Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 1140
Bettendorf, IA 52722
Phone (563) 359-9805

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1415 11th St
Ste C
De Witt, IA 52742
Phone (563) 659-6090

2422 12th Street Ct
De Witt, IA 52742
Phone (563) 659-6090

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737763200000",
    "number": "1265104707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 12TH STREET CT",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421225",
            "telephone_number": "563-659-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 12TH STREET CT",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421225",
            "telephone_number": "563-659-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "NANCY",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-04",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A165449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Witt, IA

Sources for this page

Verify at the official NPI Registry.