Provider Demographics
NPI:1023720984
Name:ROBERTS, FAY ANGELLA
Entity type:Individual
Prefix:MS
First Name:FAY
Middle Name:ANGELLA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 NORTHPARK AVE # 260
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-9700
Mailing Address - Country:US
Mailing Address - Phone:260-356-2875
Mailing Address - Fax:260-356-6241
Practice Address - Street 1:2860 NORTHPARK AVE # 260
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9700
Practice Address - Country:US
Practice Address - Phone:260-356-2875
Practice Address - Fax:260-356-6241
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28236840A163WP0809X
IN71013657A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult