Provider Demographics
NPI:1720554256
Name:ROBERSON, KAY MARIE (CPC, CAA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:MARIE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:CPC, CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-5000
Mailing Address - Country:US
Mailing Address - Phone:564-397-7669
Mailing Address - Fax:360-397-8476
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD STE A-152
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:564-397-7669
Practice Address - Fax:360-397-8476
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist