Healthcare Provider Details

I. General information

NPI: 1134760168
Provider Name (Legal Business Name): LENICE ROBERSON CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S 4TH ST STE 700
LOUISVILLE KY
40202-3046
US

IV. Provider business mailing address

1728 SAN JOSE AVE
LOUISVILLE KY
40216-2768
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-9399
  • Fax: 502-628-2536
Mailing address:
  • Phone: 502-350-9399
  • Fax: 502-628-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL8P3T5F2
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: