Provider Demographics
NPI:1992769962
Name:ROBERTS-MANSON, KERRY K (PHD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:ROBERTS-MANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1738
Mailing Address - Country:US
Mailing Address - Phone:775-322-0111
Mailing Address - Fax:
Practice Address - Street 1:427 RIDGE ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1717
Practice Address - Country:US
Practice Address - Phone:775-322-0111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0346103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2616310Medicaid
NV30253Medicare ID - Type Unspecified