Provider Demographics
NPI:1508057316
Name:ROBERTS, KAY DEE (PA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:DEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:38460 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4685
Mailing Address - Country:US
Mailing Address - Phone:661-273-1614
Mailing Address - Fax:661-273-4816
Practice Address - Street 1:41230 11TH ST W STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1411
Practice Address - Country:US
Practice Address - Phone:661-273-1614
Practice Address - Fax:661-273-4816
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA011543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical