Provider Demographics
NPI:1316150428
Name:GLENN-ROBERTS, KATHLEEN J (RPA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:GLENN-ROBERTS
Suffix:
Gender:
Credentials:RPA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23 HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2000
Mailing Address - Country:US
Mailing Address - Phone:518-561-1322
Mailing Address - Fax:518-561-3420
Practice Address - Street 1:75 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1427
Practice Address - Country:US
Practice Address - Phone:518-562-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY06946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMG0361561OtherDEA