Individual provider Active NPI

Kristine Lynn Roberts-Large, REGISTERED NURSE

  • General Practice Registered Nurse
  • Vero Beach, FL
National Provider Identifier
1801685003
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
9681677 Issued in FL
Practice address
6200 20TH St Ste 318
Vero Beach, FL 32966-1079
Phone
(772) 307-9840
NPI assigned
May 5, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 9681677 FL Primary

Addresses

Primary practice location

6200 20TH St Ste 318
Vero Beach, FL 32966-1079

Mailing address

2160 58TH Ave # 318
Vero Beach, FL 32966-4647
Phone (772) 307-9840

Other identifiers 1

IdentifierTypeStateIssuer
1881098416MedicaidFL

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

LicenseStateTypeSpecialty
9681677FLMDGeneral Practice Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1801685003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 58TH AVE # 318",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329664647",
            "telephone_number": "772-307-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 20TH ST STE 318",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329661079",
            "telephone_number": "772-307-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS-LARGE",
        "first_name": "KRISTINE",
        "middle_name": "LYNN",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "9681677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881098416",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.