Provider Demographics
NPI:1689676041
Name:ROBERTS, KAREN JEAN (ACNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:JEAN
Other - Last Name:BROCKLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:7 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-368-8500
Practice Address - Fax:706-307-4613
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA954318954BMedicaid
GA954318954AMedicaid
GA954318954BMedicaid
GA511I500904Medicare PIN