Provider Demographics
NPI:1184245839
Name:ROBERTS, KASEY LEIGH (LVN)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LEIGH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:LEIGH
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:5408 46TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-1514
Mailing Address - Country:US
Mailing Address - Phone:806-773-3350
Mailing Address - Fax:
Practice Address - Street 1:5408 46TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-1514
Practice Address - Country:US
Practice Address - Phone:806-773-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219977164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse