Individual
KATIE RENEE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
647 N BROAD STREET EXT, STE 201, GROVE CITY, PA 16127-4604
(724) 264-4190
(724) 264-4194
Mailing address
647 N BROAD STREET EXT, STE 201, GROVE CITY, PA 16127-4604
(724) 264-4190
(724) 264-4194
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA052721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11976922
CAQH
—
05
—
1J4395
—
PA
Enumeration date
05/14/2008
Last updated
09/11/2021
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