MEDICARE: KIMBERLY FAITH ROBERTS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN287597	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184941338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FAITH ROBERTS CNP

Provider Business Mailing Address
First Line	:	5964 GOLF CLUB LN
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-8224
Country	:	US
Telephone Number	:	513-893-1100
Fax Number	:	513-893-1128

Provider Business Practice Location Address
First Line	:	5964 GOLF CLUB LN
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-8200
Country	:	US
Telephone Number	:	513-893-1100
Fax Number	:	513-893-1128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	10/30/2012

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