Provider Demographics
NPI:1275142440
Name:ROBERSON-WHITE, KENTORIA I'SHARRELL
Entity Type:Individual
Prefix:MRS
First Name:KENTORIA
Middle Name:I'SHARRELL
Last Name:ROBERSON-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BROOK SPRING DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4968
Mailing Address - Country:US
Mailing Address - Phone:214-266-1400
Mailing Address - Fax:
Practice Address - Street 1:4201 BROOK SPRING DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4968
Practice Address - Country:US
Practice Address - Phone:214-266-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily