Provider Demographics
NPI:1962215871
Name:ROBERTS, KI'YANA NICOLE
Entity type:Individual
Prefix:
First Name:KI'YANA
Middle Name:NICOLE
Last Name: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:PO BOX 721627
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-1627
Mailing Address - Country:US
Mailing Address - Phone:405-613-2037
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 124
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4292
Practice Address - Country:US
Practice Address - Phone:405-613-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management