MEDICARE: KRISTEN M ROBERTS PA-C

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	363A00000X	Physician Assistant	50.005907RX	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	:	1669931218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M ROBERTS PA-C

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-517-0146
Fax Number	:

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

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	01/21/2026

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