Provider Demographics
NPI:1184941338
Name:ROBERTS, KIMBERLY FAITH (CNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAITH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 GOLF CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8224
Mailing Address - Country:US
Mailing Address - Phone:513-893-1100
Mailing Address - Fax:513-893-1128
Practice Address - Street 1:5964 GOLF CLUB LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8200
Practice Address - Country:US
Practice Address - Phone:513-893-1100
Practice Address - Fax:513-893-1128
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN287597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3069718Medicaid
OHNP36242Medicare PIN