Provider Demographics
NPI:1497811137
Name:ROBERTS, PATRICIA KAY
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
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 1:19727 W NARRAMORE RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-4238
Mailing Address - Country:US
Mailing Address - Phone:623-691-6313
Mailing Address - Fax:
Practice Address - Street 1:19727 W NARRAMORE RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-4238
Practice Address - Country:US
Practice Address - Phone:623-691-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ954116385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child