Healthcare Provider Details

I. General information

NPI: 1124649595
Provider Name (Legal Business Name): ANDREW SCOTT ROBERTS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 CANOE CREEK DR
HENDERSON KY
42420-4688
US

IV. Provider business mailing address

668 CANOE CREEK DR
HENDERSON KY
42420-4688
US

V. Phone/Fax

Practice location:
  • Phone: 270-836-7323
  • Fax:
Mailing address:
  • Phone: 270-836-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30009010A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: