Provider Demographics
NPI:1407333446
Name:ROBERTSON, KIMBERLY ANN (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCHNECK SPECIALTY ASSOCIATES
Mailing Address - Street 2:225 S PINE ST, STE 300
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-523-7893
Mailing Address - Fax:812-523-7896
Practice Address - Street 1:225 S PINE ST STE 300
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2367
Practice Address - Country:US
Practice Address - Phone:812-523-7893
Practice Address - Fax:812-523-7896
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012049A363LG0600X
CO0993998363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology