Nikole K Roberts, PHD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2019037970 Issued in MO

Practice address

1300 E Bradford Pkwy BLDG B
Springfield, MO 65804-4264

Phone

(417) 761-5000

Fax

(417) 761-5065

NPI assigned

Jun 25, 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

Other identifiers 1

Other names 1

• Kimberly Nikole Roberts Former name

Medicare fee-for-service enrollment

Enrolled in NC, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Burrell IncGroup PAC ID 4486548625, 217 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• A & N Telepsych Assessment Associates LLC

  • Group Psychotherapy Psychologist
  • Springfield, MO
  • NPI 1568262582
  Medicare reassignment NPD Authorized official
• Burrell, Inc.

  • Community/Behavioral Health Agency
  • Springfield, MO
  • NPI 1275541740
  Medicare reassignment Care Compare group NPD
• Lecci Psychological Services, PLLC

  • Psychologist
  • Wilmington, NC
  • NPI 1811976426
  Medicare reassignment NPD
• Burrell, Inc.

  • Community/Retail Pharmacy
  • Springfield, MO
  • NPI 1194190066
  NPD

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1730740366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2885 W BATTLEFIELD ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658073952",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY BLDG B",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044264",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 E Bradford Pkwy",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658044376",
            "country_code": "US",
            "telephone_number": "417-761-5850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "NIKOLE",
        "middle_name": "K",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2019037970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14491942",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ROBERTS",
            "middle_name": "NIKOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anne Elizabeth Roberts, M.D.
• Donna M Roberts, MD
• Megan Ann-Melugin Roberts, PT, DPT
• Nancy Ellen Roberts, N.P.
• Nathan Roberts, M.D.
• Sharron L Roberts, LPC
• Tifini Autumn Roberts, PSY.D.
• Tracy Lynn Roberts, M.D.
• Zachary C Roberts, ATC, CSCS
• Allison J Robertson, MSW, LCSW

• Clinical Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; 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.