Provider Demographics
NPI:1437916285
Name:ROBERTS, KELLY LYM
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYM
Last Name:ROBERTS
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 1:266 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1551
Mailing Address - Country:US
Mailing Address - Phone:812-605-3425
Mailing Address - Fax:
Practice Address - Street 1:266 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1551
Practice Address - Country:US
Practice Address - Phone:812-605-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider