Provider Demographics
NPI:1225552029
Name:ROBERTS, NATASHA L (APRN)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1019 CUMBERLAND FALLS HWY
Mailing Address - Street 2:SUITE B201
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2735
Mailing Address - Country:US
Mailing Address - Phone:606-526-9005
Mailing Address - Fax:606-526-8606
Practice Address - Street 1:85 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8801
Practice Address - Country:US
Practice Address - Phone:606-596-0410
Practice Address - Fax:606-528-8272
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2019-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3011493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100475780Medicaid