Provider Demographics
NPI:1194045104
Name:ROBERTS, EDITH L (APRN)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:L
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1419 CUMBERLAND FALLS HWY
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2722
Mailing Address - Country:US
Mailing Address - Phone:606-526-9005
Mailing Address - Fax:
Practice Address - Street 1:1419 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2722
Practice Address - Country:US
Practice Address - Phone:606-526-9005
Practice Address - Fax:606-528-6531
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6448P363LF0000X
KY3006448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100119120Medicaid