Provider Demographics
NPI:1982630885
Name:ROBERTS, JENNIFER FELLINI (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FELLINI
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:FELLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2608
Mailing Address - Fax:855-890-8382
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-367-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP19594Medicaid
0PA143891Medicare PIN
CABN181ZMedicare Oscar/Certification
CR0087Medicare PIN
P00136844Medicare PIN
CANP19594Medicaid
ZZZ34627ZMedicare PIN