Provider Demographics
NPI:1730286360
Name:ROBERTS, LAURIE (ARNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1644
Mailing Address - Country:US
Mailing Address - Phone:270-825-7200
Mailing Address - Fax:270-326-4968
Practice Address - Street 1:1010 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5463
Practice Address - Country:US
Practice Address - Phone:270-377-1600
Practice Address - Fax:270-326-4968
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01099331OtherRR MEDICARE- POWDERLY
KY2916POtherLICENSE
KY78029162Medicaid
000000186602OtherBCBS PROVIDER NUMBER
KYP01099331OtherRR MEDICARE- POWDERLY
0375348Medicare PIN
0396841Medicare PIN
0525647Medicare PIN
0375149Medicare PIN
KY78029162Medicaid
KY500009518Medicare PIN
0375096Medicare PIN
S78512Medicare UPIN
0570216Medicare PIN
KYK065960Medicare PIN
0375250Medicare PIN
0374752Medicare PIN
0374650Medicare PIN
000000186602OtherBCBS PROVIDER NUMBER