Individual
SANDRA D ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1311 N DIXIE HWY, ELIZABETHTOWN, KY 42701-2621
(270) 769-1304
(270) 234-8028
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 769-1304
(270) 234-8028
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4725P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000480985
ANTHEM
KY
01
—
11571509
CAQH
—
05
—
30605018
—
KY
Enumeration date
05/18/2006
Last updated
03/29/2008
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