Provider Demographics
NPI:1164285367
Name:ROBERTS, KAITLYN (PNP-PC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GOVERNOR DOHERTY RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-2040
Mailing Address - Country:US
Mailing Address - Phone:978-987-9427
Mailing Address - Fax:
Practice Address - Street 1:652 E WASHINGTON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2488
Practice Address - Country:US
Practice Address - Phone:508-576-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10000367363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics