Provider Demographics
NPI:1275428963
Name:ROBERTS, MADISON COURTNEY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:COURTNEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 RIDGEVIEW DR APT 1443
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0084
Mailing Address - Country:US
Mailing Address - Phone:678-338-3981
Mailing Address - Fax:
Practice Address - Street 1:230 E SYCAMORE ST STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5017
Practice Address - Country:US
Practice Address - Phone:903-202-2900
Practice Address - Fax:903-202-2901
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190015363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics