Healthcare Provider Details

I. General information

NPI: 1730078957
Provider Name (Legal Business Name): JULIE ROBERTSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 OLD FAIRGROUNDS LN LOT 4
FORT ASHBY WV
26719-1701
US

IV. Provider business mailing address

56 OLD FAIRGROUNDS LN LOT 4
FORT ASHBY WV
26719-1701
US

V. Phone/Fax

Practice location:
  • Phone: 304-703-8827
  • Fax:
Mailing address:
  • Phone: 304-703-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: