Provider Demographics
NPI:1265852909
Name:ROBERTS, WHITNEY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ANN
Other - Last Name:EGBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1828 S MILLENIUM WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5036
Mailing Address - Country:US
Mailing Address - Phone:208-895-8775
Mailing Address - Fax:208-895-1775
Practice Address - Street 1:1828 S MILLENIUM WAY STE 300
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5036
Practice Address - Country:US
Practice Address - Phone:208-895-8775
Practice Address - Fax:208-895-1775
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant