Provider Demographics
NPI:1104471382
Name:ROBERTS, JUANITA CAROLYN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:CAROLYN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:CAROLYN
Other - Last Name:CARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3464
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3464
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207709363LP0808X
TX1142633363LP0808X
WA61359549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health