Provider Demographics
NPI:1114082906
Name:ROBERTSON, KATHRYN COLLEEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:COLLEEN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8381
Mailing Address - Country:US
Mailing Address - Phone:208-265-9532
Mailing Address - Fax:208-263-5112
Practice Address - Street 1:302 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1258
Practice Address - Country:US
Practice Address - Phone:208-263-5109
Practice Address - Fax:208-263-5112
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8055221300Medicaid
IDS67499Medicare UPIN
ID134182Medicare ID - Type Unspecified