Healthcare Provider Details

I. General information

NPI: 1265852909
Provider Name (Legal Business Name): WHITNEY ANN ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY ANN EGBERT PA-C

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 S MILLENIUM WAY STE 300
MERIDIAN ID
83642-5036
US

IV. Provider business mailing address

1828 S MILLENIUM WAY STE 300
MERIDIAN ID
83642-5036
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-8775
  • Fax: 208-895-1775
Mailing address:
  • Phone: 208-895-8775
  • Fax: 208-895-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1122
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: