Provider Demographics
NPI:1144346289
Name:ROBERSON, JOY K (PA-C)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:K
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:M
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:WELLNESS CENTER
Mailing Address - Street 2:820 FOLLIN LANE SE
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:877-222-8808
Mailing Address - Fax:703-206-1371
Practice Address - Street 1:820 FOLLIN LN SE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4907
Practice Address - Country:US
Practice Address - Phone:877-222-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical