=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851702997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KOURTNE ROBERTS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2014
-----------------------------------------------------
Last Update Date | 04/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3904 JOHN STOCKBAUER DR STE 101
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-703-5026
-----------------------------------------------------
Fax | 361-703-5394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3904 JOHN STOCKBAUER DR STE 101
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-703-5026
-----------------------------------------------------
Fax | 361-703-5394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | R0312
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------