Kenneth L Robertson, MD FACP

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2617A Issued in WY

Practice address

3116 Willett Dr
Laramie, WY 82072

Phone

(307) 745-8800

Fax

(307) 745-4150

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivinson Memorial Hospital

  • Rural Health Clinic/Center
  • Laramie, WY
  • NPI 1033628599
  Medicare reassignment NPD
• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1366626269
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831101609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 WILLETT DR",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "82072",
            "telephone_number": "307-745-8800",
            "fax_number": "307-745-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 WILLETT DR",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "82072",
            "telephone_number": "307-745-8800",
            "fax_number": "307-745-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KENNETH",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "MD FACP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "2617A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryellen Agnes Riley, WHNP, RN,C, MS
• Faith Smith Rima
• Rachel Antrim Ritter, M.S. CCC-SLP
• Tiauna Roberts
• Karen Ellen Robertson, MS, BC-TMH, LPC, NCC
• Taylen Mae Robertson
• Ian Robinson
• Kyler Robinson
• Makayla Robinson
• Pamela Robinson

• Internal Medicine Physician in Laramie, WY
• Providers in Laramie, WY by specialty
• Internal Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.