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Provider Information for 1750920922


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KIMBERLY LYNN ROBERTS


Other Names:  
Former Name: 
KIMBERLY LYNN MCCAFFERTY

Sex: Female

NPI: 1750920922
Last Updated: 2020-01-05
Certification Date: 2020-01-05

Details

NameValue
NPI1750920922
Enumeration Date2020-01-05
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 68 SHIRLEY DR
TROY, MO 63379-6304
United States

Phone: 636-290-8147 | Fax:
 
Primary Practice Address 68 SHIRLEY DR
TROY, MO 63379-6304
United States

Phone: 636-290-8147 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMO2019047659