Provider Demographics
NPI:1578382180
Name:ROBERTS, KIWANIS YO'MONE II
Entity type:Individual
Prefix:
First Name:KIWANIS
Middle Name:YO'MONE
Last Name:ROBERTS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721581
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-1581
Mailing Address - Country:US
Mailing Address - Phone:405-727-0138
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 124
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4292
Practice Address - Country:US
Practice Address - Phone:405-727-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator