Jeffrey Roberts, LPN,WCN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN-15716 Issued in ID

Practice address

620 S Elder St
Nampa, ID 83686-5212

Phone

(208) 465-7659

NPI assigned

Jul 16, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Jeffrey Donald Roberts Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Divinity Healthcare Services PLLC

  dba Divinity

  • Home Health Agency
  • Nampa, ID
  • NPI 1770995219
  NPD Authorized official

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1497162986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 S ELDER ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865212",
            "telephone_number": "208-465-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S ELDER ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865212",
            "telephone_number": "208-465-7659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JEFFREY",
        "name_prefix": "Mr.",
        "credential": "LPN,WCN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "ID",
            "license": "PN-15716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFFREY",
            "last_name": "ROBERTS",
            "middle_name": "DONALD",
            "prefix": "MR.",
            "credential": "LPN, WCN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Bonnie Alaine Walser Rivas, CNM
• Mary E River, MD
• Erika Lynn Rivera, LMSW
• Peter G Roan, MD
• Bette Robbins, RPH
• John Aaron Roberts, PHARMD
• Rick N. Roberts, M.D.
• Steve Edward Roberts, MD
• Edward Harry Robertson Jr.
• Joseph Robinson, PA

• Licensed Practical Nurse in Nampa, ID
• Providers in Nampa, ID by specialty
• Licensed Practical Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.