Provider Demographics
NPI:1386077295
Name:ROBERSON, KENYIA (RRT)
Entity type:Individual
Prefix:
First Name:KENYIA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 HERMAN B RADER DR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2122
Mailing Address - Country:US
Mailing Address - Phone:615-293-9606
Mailing Address - Fax:
Practice Address - Street 1:3042 HERMAN B RADER DR
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2122
Practice Address - Country:US
Practice Address - Phone:615-293-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4121227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered