Jacquelyn Roberts, MSN, APRN, FNP-C,

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN2310867 Issued in MA

Practice address

11 Salem St Ste 15
Medford, MA 02155-3262

Phone

(617) 299-0440

NPI assigned

Feb 27, 2021

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing

State licenses

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

{
    "created_epoch": "1614384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614384000000",
    "number": "1790379972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 MITCHELL AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551736",
            "telephone_number": "978-808-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SALEM ST STE 15",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553262",
            "telephone_number": "617-299-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACQUELYN",
        "credential": "MSN, APRN, FNP-C,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-27",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2310867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riverside Chiropractic Wellness Centers, Inc
• Riverway Counseling Associates
• Rivka Simmons
• Robert P. Williamson MD, P.C.
• Erin Roberts
• Charles Robertson, DO
• Robin Hasenfeld, PH.D., PC
• Reilly Roche, APRN
• Deborah Rochman, OT
• Adeline Gilles Rodriguez

• Nurse Practitioner in Medford, MA
• Providers in Medford, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2021; 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.