Provider Demographics
NPI:1821191230
Name:ROBERTS, VICKI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
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:PO BOX 1571
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-1571
Mailing Address - Country:US
Mailing Address - Phone:270-442-1223
Mailing Address - Fax:270-442-1223
Practice Address - Street 1:2320 BROADWAY
Practice Address - Street 2:SUITE 403
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-442-1223
Practice Address - Fax:270-442-1223
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E39161Medicare UPIN