Courtney White Roberson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

27094 Issued in TN

Practice address

1575 Parr Ave, Suite B
Dyersburg, TN 38024

Phone

(731) 286-1510

Fax

(731) 286-1510

NPI assigned

Jan 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

West Tennessee Bone and Joint Clinic PCGroup PAC ID 7517940182, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center Home Health LLC Home health agency, Jackson, TN, CCN 447101
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: courtney.roberson.1@3533.direct.athenahealth.com

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.

• West Tennessee Bone and Joint Clinic PC

  • Specialist
  • Jackson, TN
  • NPI 1831312461
  Medicare reassignment Care Compare group NPD
• Kidney Experts PLLC

  • Nephrology Physician
  • Dyersburg, TN
  • NPI 1225529142
  Medicare reassignment NPD

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

• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Medical Center Home Health, LLC

  • Home Health Agency
  • Jackson, TN
  • NPI 1932355997
  Care Compare affiliation

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1366073041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 W. UNIVERSITY PKWY, SUITE C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-286-1510",
            "fax_number": "731-286-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 PARR AVE, SUITE B",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-286-1510",
            "fax_number": "731-286-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "COURTNEY",
        "middle_name": "WHITE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-30",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "27094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul William Rettinger, PHARM.D.
• Revitalize Counseling & Consultation Services
• Anne Barret Richards, MSN, APRN, FNP-C
• Jane Alison Riles, DNP-C
• Riverside Surgery Center, LLC
• Elizabeth Roberson, FNP
• David Allen Roberts, PA-C
• Michelle Renee Roberts, FNP-BC
• Erica Nicole Robertson
• Katelyn Meredith Robertson, RN, APRN, NP-C

• Nurse Practitioner in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.