Nikisha Nicole Roberts, MPH PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102619 Issued in FL

Practice address

1989 W Lumsden Rd
Brandon, FL 33511-8821

Phone

(813) 653-3111

Fax

(813) 653-1384

NPI assigned

Sep 1, 2006

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

• Ms. Nikisha Nicole Walker Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: nikisha.roberts@wellmed.eclinicaldirectplus.com

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.

• Optumcare Florida LLC

  • General Practice Physician
  • Tampa, FL
  • NPI 1053384214
  Medicare reassignment Care Compare group NPD
• Optumcare Florida, LLC

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1659884294
  NPD
• Optumcare Florida Ci, LLC

  • Primary Care Clinic/Center
  • Winter Park, FL
  • NPI 1720506603
  NPD (past)
• Silver Wings Independence at Home LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Pinellas Park, FL
  • NPI 1407128234
  NPD (past)

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1881796035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1989 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118821",
            "telephone_number": "813-653-3111",
            "fax_number": "813-653-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118821",
            "telephone_number": "813-653-3111",
            "fax_number": "813-653-1384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "NIKISHA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "MPH PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101660400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKISHA",
            "last_name": "WALKER",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "MPH PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jada Nicole Roberson
• Alyssa Roberts
• Diane Elizabeth Roberts, RMHCI, ATR-P
• Ebony Roberts
• Mackenzie Roberts
• Valencia Chavala Roberts
• Jaclyn Robertson
• Juliann Robertson
• Kristen Robertson, P.T.
• Lauren Fay Robertson, MD

• Physician Assistant in Brandon, FL
• Providers in Brandon, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.
• 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.