Provider Demographics
NPI:1902687866
Name:ROBERTS-STARK, AMY E (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:ROBERTS-STARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1418
Mailing Address - Country:US
Mailing Address - Phone:503-348-2214
Mailing Address - Fax:
Practice Address - Street 1:1624 S NELSON ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1418
Practice Address - Country:US
Practice Address - Phone:503-348-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60575183163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health