Basic Information
| Provider Information | |||||||||
| NPI: | 1033477088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLBERT | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4190 | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255044190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049089201 | ||||||||
| FaxNumber: | 3049353334 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CHATEAU LN | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047364700 | ||||||||
| FaxNumber: | 3047364029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TP056 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04205 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2791 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0138433 | 05 | OH | MEDICAID |