Provider Demographics
NPI:1770844144
Name:ROBERTS, KYLEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:NH
Mailing Address - Zip Code:03582-4061
Mailing Address - Country:US
Mailing Address - Phone:603-636-1101
Mailing Address - Fax:
Practice Address - Street 1:47 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:NH
Practice Address - Zip Code:03582-4061
Practice Address - Country:US
Practice Address - Phone:603-636-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20636207Q00000X
NV17946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770844144Medicaid
14240674OtherCAQH