Provider Demographics
NPI:1801592944
Name:ROBERSON, KEYATIA R
Entity type:Individual
Prefix:MS
First Name:KEYATIA
Middle Name:R
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19414 MAPLE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2380
Mailing Address - Country:US
Mailing Address - Phone:216-538-4784
Mailing Address - Fax:
Practice Address - Street 1:19414 MAPLE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2380
Practice Address - Country:US
Practice Address - Phone:216-538-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty