NPI 1265754329

Kenrick L Roberts, PHYSICIANASSISTANT

Practitioner Physician Assistant Evergreen Park, IL

Practice location

Address: 2850 W 95th St Suite 301, Evergreen Park, IL 60805-2735
Phone: (708) 389-2200
Mailing address: PO Box 26975, Jacksonville, FL 32226-6975

Registered specialties (3)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 085-003520 (IL)

Other Physician Assistant providers in Illinois →

Medical Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 085003520 (IL)

Surgical Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence 085003520 (IL)

Registry record

NPI: 1265754329
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 Feb 2010
Record last updated: 29 Apr 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.