NPI 1104168459 · live from the CMS NPI Registry
Jessiela Venis Roberts, M.D.
Family Medicine in Fort Smith, AR. National Provider Identifier 1104168459, active.
NPI record
| NPI | 1104168459 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 612 S 12th St, Fort Smith, AR 72901 |
| Practice phone | 479-785-2431 |
| Mailing address | 410 W Brinkley Loop, Apt. 2, Marion, AR 72364 |
| Enumerated | March 25, 2013 |
| Last updated | April 24, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | E-9138 (AR) |
| Family Medicine, Hospice and Palliative Medicine | 207QH0002X | E-9138 (AR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.