Provider Demographics
NPI:1326036104
Name:ROBERTS, KEVIN JAY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WALDEN RIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8586
Mailing Address - Country:US
Mailing Address - Phone:828-684-0414
Mailing Address - Fax:828-684-0677
Practice Address - Street 1:3 WALDEN RIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8587
Practice Address - Country:US
Practice Address - Phone:828-684-0414
Practice Address - Fax:828-684-0677
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC72192OtherBCBS ID
NC8972192Medicaid
NC72192OtherBCBS ID
NCC82126Medicare UPIN