Active NPI
Roberta Carol Villa, RN
- Licensed Practical Nurse
- Warm Springs, OR
National Provider Identifier
1821306085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 83433
- Practice address
- 1270 Kot-Num Road
Warm Springs, OR 97761 - Phone
- (541) 553-1196
- Fax
- (541) 553-2135
- NPI assigned
- Sep 21, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 83433 | OK | Primary |
Addresses
Primary practice location
1270 Kot-Num Road
Warm Springs, OR 97761
Mailing address
PO Box 1209
1270 Kot Num Road
Warm Springs, OR 97761-1209
Phone (541) 553-1196
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MCR HS2204 | Other | MEDICARE | |
| 273855 | Medicaid | OR |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83433 | OK | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285027200000",
"number": "1821306085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1209",
"address_2": "1270 KOT NUM ROAD",
"city": "WARM SPRINGS",
"state": "OR",
"postal_code": "977611209",
"telephone_number": "541-553-1196",
"fax_number": "541-553-2135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1270 KOT-NUM ROAD",
"city": "WARM SPRINGS",
"state": "OR",
"postal_code": "97761",
"telephone_number": "541-553-1196",
"fax_number": "541-553-2135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "ROBERTA",
"middle_name": "CAROL",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-21",
"last_updated": "2010-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OK",
"license": "83433",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "MCR HS2204",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273855",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warm Springs, OR
- Constance Jean Street, RN
- Denise Swift, R.N.
- Vincent Joaquin Tavalez, PHARMD
- The Confederated Tribes of the Warm Springs Reservation of Oregon
- Hai Tuan Tran, DPM
- Marilyn J Waller-Niewold, D.P.M.
- Joanne Wallis, ANP
- Diana Jaye Wambaugh, NURSE PRACTITIONER
- Warm Springs Health and Wellness Center
- Warm Springs Health and Wellness Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.