Healthcare Provider Details

I. General information

NPI: 1053307090
Provider Name (Legal Business Name): KATHLEEN ANNE ROBERTS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

IV. Provider business mailing address

6025 STAGE RD STE 42-415
BARTLETT TN
38134-8374
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-6000
  • Fax: 503-352-6081
Mailing address:
  • Phone: 901-498-0054
  • Fax: 888-419-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95193472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5173
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211353
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60728469
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201708253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: