Healthcare Provider Details

I. General information

NPI: 1164285367
Provider Name (Legal Business Name): KAITLYN ROBERTS PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 E WASHINGTON ST UNIT 2
NORTH ATTLEBORO MA
02760-2488
US

IV. Provider business mailing address

10 GOVERNOR DOHERTY RD
BILLERICA MA
01821-2040
US

V. Phone/Fax

Practice location:
  • Phone: 508-576-5010
  • Fax:
Mailing address:
  • Phone: 978-987-9427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN10000367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: