Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 39075 | KY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 39075 | KY |
NPI | 1023022738 |
---|---|
Provider Name | Kittye R Roberts |
First Address | Lexington, KY 40508-3215 |
Second Address | Lexington, KY 40536-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64090194 | (05) | KY |
A74153 | (02) |