Provider Demographics
NPI:1386608511
Name:ROBERTS, RONA JEAN (MD)
Entity type:Individual
Prefix:
First Name:RONA
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3367
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-3367
Mailing Address - Country:US
Mailing Address - Phone:502-813-6655
Mailing Address - Fax:502-813-6665
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-852-1951
Practice Address - Fax:502-852-5098
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY396637OtherTRICARE
KY64297302Medicaid
IN200466850Medicaid
IN200466850Medicaid
H96880Medicare UPIN
KY396637OtherTRICARE
KY64297302Medicaid