Active NPI
Kaleb Roberts
- Registered Nurse
- Johnson City, TN
National Provider Identifier
1548637366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 202420
- Practice address
- 2918 S Greenwood Dr
Apt 20
Johnson City, TN 37604-3261 - Phone
- (276) 219-1884
- NPI assigned
- Aug 27, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 202420 | TN | Primary |
Addresses
Primary practice location
2918 S Greenwood Dr
Apt 20
Johnson City, TN 37604-3261
Mailing address
2918 S Greenwood Dr Apt 20
Johnson City, TN 37604-3262
Phone (276) 219-1884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202420 | TN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440633600000",
"number": "1548637366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2918 S GREENWOOD DR APT 20",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376043262",
"telephone_number": "276-219-1884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2918 S GREENWOOD DR",
"address_2": "APT 20",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376043261",
"telephone_number": "276-219-1884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KALEB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-27",
"last_updated": "2015-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TN",
"license": "202420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.