Provider Demographics
NPI:1326676578
Name:ROBERTSON, APRIL ROANN
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:ROANN
Last Name:ROBERTSON
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 1:1100 MARQUIS TRCE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3750
Mailing Address - Country:US
Mailing Address - Phone:270-300-6819
Mailing Address - Fax:
Practice Address - Street 1:4602 SOUTHERN PKWY STE 1A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1442
Practice Address - Country:US
Practice Address - Phone:270-300-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1173259175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty