Provider Demographics
NPI:1851097646
Name:ROBERTS, KAROLYN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:KAROLYN
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 GALLANT DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-2002
Mailing Address - Country:US
Mailing Address - Phone:859-608-0989
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-257-3533
Practice Address - Fax:859-257-6024
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics