Provider Demographics
NPI:1366759839
Name:ROBERTS, MOLLY SPEIGHT (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:SPEIGHT
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:SPEIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-331-2505
Mailing Address - Fax:864-331-2510
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-331-2505
Practice Address - Fax:864-331-2510
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005751363A00000X
NC0010-02457363A00000X
SC3314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF4201298OtherMEDICARE PTAN