KENRICK L ROBERTS (NPI# 1265754329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265754329 |
| Entity Type | Individual |
| Full Name | KENRICK L ROBERTS |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
2850 W 95th St Suite 301 Evergreen Park IL 60805-2735 |
| Mailing Address |
Po Box 26975 Jacksonville FL 32226-6975 |
| Practice Telephone | 7083892200 |
| Mailing Telephone | 7734505709 |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2020-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-003520 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
085003520 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085003520 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386637122 | Kenrick Hamilton Roberts | Dermatology | 100 Welton Dr, Cumberland, MD 21502-1336 | 2005-08-26 |
| Street Address |
2850 W 95TH ST SUITE 301 |
| City | EVERGREEN PARK |
| State | IL |
| Zip Code | 60805-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598760480 | Michael R Fiorucci | Surgery | 2850 W 95th St, Suite 306, Evergreen Park, IL 60805-2735 | 2005-06-16 |
| 1295197697 | Shina Keaonis Gordon | Nurse Practitioner | 2850 W 95th St, Evergreen Park, IL 60805-2735 | 2016-03-24 |
| 1659757888 | Yvonne Oldaker | Advanced Practice Midwife | 2850 W 95th St, Evergreen Park, IL 60805-2735 | 2015-08-11 |
| 1386037984 | Leslie Kelly | Nurse Practitioner | 2850 W 95th St, Evergreen Park, IL 60805-2735 | 2015-03-06 |
| 1558754291 | Gina Marie Chigaros | Counselor | 2850 W 95th St, Mary Potter Pavilion Suite 403, Evergreen Park, IL 60805-2735 | 2015-03-05 |
| 1629487806 | Deon Shere Cooper | Registered Nurse | 2850 W 95th St, Suite 301, Evergreen Park, IL 60805-2735 | 2014-08-12 |
| 1750621884 | Cynthia M Hayes | Clinical Nurse Specialist | 2850 W 95th St, Evergreen Park, IL 60805-2735 | 2013-02-27 |
| 1336488212 | The Cardiology Group | Clinical Nurse Specialist | 2850 W 95th St, Suite 305, Evergreen Park, IL 60805-2735 | 2013-02-12 |
| 1255608808 | Kunhunn Vellody Md | Clinic/Center | 2850 W 95th St, Suite 201, Evergreen Park, IL 60805-2735 | 2011-11-28 |
| 1457649121 | Ryan Kukor | Internal Medicine | 2850 W 95th St, Suite 102, Evergreen Park, IL 60805-2735 | 2011-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254603 | Cynthia Nicole Bucio | Pharmacist | 9400 S. Western, Evergreen Park, N/A 60805 | 2020-10-27 |
| 1124530456 | Foundations Counseling, LLC | Social Worker | 9730 S Western Ave Ste 215, Evergreen Park, IL 60805 | 2017-10-26 |
| 1184147886 | Luke Blaeser | Specialist/Technologist | 2856 W. 97th Pl., Evergreen Park, IL 60805 | 2017-07-25 |
| 1396193322 | Daniel Joseph Bierbaum Howard | Emergency Medicine | 2800 95th St, Emergency Department, Evergreen Park, IL 60805 | 2016-05-31 |
| 1588037873 | Lcr Primary Care LLC | Exclusive Provider Organization | 9237 S.pulaski, Ste. 2s, Evergreen Park, IL 60805 | 2015-11-09 |
| 1447639091 | Nancy Sanchez | Social Worker | 9832 S Utica Ave, Evergreen Park, IL 60805 | 2015-05-28 |
| 1629334743 | Harshad M. Mehta Md Sc | Psychiatry & Neurology | 2850 W. 95th Street, Suite 206, Evergreen Park, IL 60805 | 2012-04-03 |
| 1235407305 | Victoria T Adesina | Pharmacist | 8700 South Kedzie Ave, Evergreen Park, IL 60805 | 2011-12-05 |
| 1891072922 | Zahia-lena Refat Hussien | Pharmacist | 8700 S. Kedzie Ave, Evergreen Park, IL 60805 | 2011-11-03 |
| 1891079091 | Denise Adams | Occupational Therapy Assistant | 9217 S. Kedzie, Evergreen Park, IL 60805 | 2011-10-06 |
| Find all providers in zip 60805 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134639008 | Jessica Schafer | Physician Assistant | 9760 S Kedzie Ave Ste 3, Evergreen Park, IL 60805-3184 | 2017-10-05 |
| 1225679699 | Natalia Adriana Cotton | Physician Assistant | 3749 W 95th St, Evergreen Park, IL 60805-2019 | 2019-10-07 |
| 1386203610 | Taylor Morgan Tigue | Physician Assistant | 2800 W 95th St, Evergreen Park, IL 60805-2795 | 2019-06-11 |
| 1003390089 | Julie Chang | Physician Assistant | 3749 W 95th St, Evergreen Park, IL 60805-2019 | 2018-09-17 |
| 1518445543 | Christine Najarian | Physician Assistant | 9760 S Kedzie Ave, Evergreen Park, IL 60805-3109 | 2018-08-01 |
| 1972002491 | Juli Dziuban | Physician Assistant | 2800 W 95th St, Evergreen Park, IL 60805-2701 | 2018-02-10 |
| 1366961203 | Monica Lynn Hand | Physician Assistant | 3749 W 95th St, Evergreen Park, IL 60805-2019 | 2017-09-12 |
| 1457894768 | Rachel Brucas | Physician Assistant | 9760 S Kedzie Ave, Evergreen Park, IL 60805-3109 | 2016-11-18 |
| 1407306400 | Kathleen Mary Galyean | Physician Assistant | 2850 W 95th Street, Suite 400, Evergreen Park, IL 60805 | 2016-10-13 |
| 1063779270 | Stephanie J Cermak | Physician Assistant | 2850 W. 95th Street, Suite 400, Evergreen Park, IL 60805 | 2012-04-12 |
| Find all providers in EVERGREEN PARK | ||||
| City | EVERGREEN PARK |
| Zip Code | 60805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.