Healthcare Provider Details

I. General information

NPI: 1568152783
Provider Name (Legal Business Name): AUSTIN PARKER ROBERTS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 KY HIGHWAY 699
CORNETTSVILLE KY
41731-8749
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-476-2593
  • Fax:
Mailing address:
  • Phone: 606-633-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: