Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 52705 | KY |
N | 207Q00000X | Family Doctor | R4164 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 52705 | KY |
NPI | 1184086621 |
---|---|
Provider Name | Kathleen Roberts |
First Address | Lexington, KY 40504-3504 |
Second Address | Lexington, KY 40504-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 18/06/2020 |