Provider Demographics
NPI:1194901843
Name:ASHMORE ROBERTS, KATHLEEN H
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:H
Last Name:ASHMORE ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 N WOLVERINE RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8734
Mailing Address - Country:US
Mailing Address - Phone:907-745-8117
Mailing Address - Fax:907-745-8194
Practice Address - Street 1:9520 N WOLVERINE RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8734
Practice Address - Country:US
Practice Address - Phone:907-745-8117
Practice Address - Fax:907-745-8194
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK725155171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator