Individual
JENNIFER ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3533 SOUTHERN BLVD STE 5650, KETTERING, OH 45429-1263
(937) 294-3611
(937) 294-9010
Mailing address
3533 SOUTHERN BLVD, SUITE 5650, KETTERING, OH 45429-1264
(937) 294-3611
(937) 294-9010
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.002811
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0743039
—
OH
Enumeration date
08/26/2008
Last updated
12/17/2020
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