Individual
MS. KIMBERLY ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1708
WI
363A00000X
Physician Assistant
Primary
1708
WI
363AS0400X
Surgical Physician Assistant
1708
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007806261U
HUMANA
—
05
—
41986600
—
WI
Enumeration date
05/17/2006
Last updated
01/15/2024
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