Provider Demographics
NPI:1831922780
Name:ROBERTS, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ROBERTS
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 1:36422 BLACKFORK TRL
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-9092
Mailing Address - Country:US
Mailing Address - Phone:479-216-9899
Mailing Address - Fax:
Practice Address - Street 1:36422 BLACKFORK TRL
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-9092
Practice Address - Country:US
Practice Address - Phone:479-216-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife