Provider Demographics
NPI:1487209441
Name:ROBERTS, ALEXIS KIMYASA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KIMYASA
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 1:6506 HAMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3731
Mailing Address - Country:US
Mailing Address - Phone:216-255-1692
Mailing Address - Fax:
Practice Address - Street 1:6506 HAMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44129-3731
Practice Address - Country:US
Practice Address - Phone:216-255-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401799901015376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide