Individual
BERTHA IZAURA ROBLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
205 HOSPITAL DR STE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Mailing address
205 HOSPITAL DRIVE, SUITE A, MCKENZIE, TN 38201
(731) 352-7907
(731) 352-4459
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1621
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507308
—
TN
01
—
3380640
MEDICAID GROUP
—
01
—
PA1621
PROFESSIONAL LICENSE
TN
Enumeration date
07/09/2008
Last updated
03/17/2018
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