Provider Demographics
NPI:1811701519
Name:ROBERG, KAILEY CHRISTINE
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:CHRISTINE
Last Name:ROBERG
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 1:9502 VALARETTA DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-3609
Mailing Address - Country:US
Mailing Address - Phone:402-720-2040
Mailing Address - Fax:
Practice Address - Street 1:8123 S 196TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-5049
Practice Address - Country:US
Practice Address - Phone:402-720-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant