Michelle Renee Roberts, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26162 Issued in TN

Practice address

350 E Tickle St
Dyersburg, TN 38024-3118

Phone

(731) 394-1145

NPI assigned

Jun 5, 2019

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1548828353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 OAKVIEW AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241667",
            "telephone_number": "573-380-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E TICKLE ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243118",
            "telephone_number": "731-394-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "26162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Alison Riles, DNP-C
• Riverside Surgery Center, LLC
• Courtney White Roberson, NP
• Elizabeth Roberson, FNP
• David Allen Roberts, PA-C
• Erica Nicole Robertson
• Katelyn Meredith Robertson, RN, APRN, NP-C
• Brian Keith Robinson, O.D.
• Kyle Pendleton Rose, NP
• Rural Health Clinic of West TN PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.