Provider Demographics
NPI:1194224048
Name:ROBERSON, MOLLY (PA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3605 NORTHGATE CT STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6422
Mailing Address - Country:US
Mailing Address - Phone:812-207-2130
Mailing Address - Fax:812-207-2140
Practice Address - Street 1:9880 ANGIES WAY STE 250
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2865
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2019-07-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPA2333OtherKY LICENSE
IN10002406AOtherIN LICENSE