Provider Demographics
NPI:1811385776
Name:ROBERTS, KEITH WESLEY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WESLEY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5050 EDWARDS MILL RD
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4439
Mailing Address - Country:US
Mailing Address - Phone:540-915-3487
Mailing Address - Fax:
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6478
Practice Address - Country:US
Practice Address - Phone:919-787-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00362300363A00000X
NC001006432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant