Basic Information
Provider Information
NPI: 1215464961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBINSON
FirstName: KERRY
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 531797
Address2:  
City: ATLANTA
State: GA
PostalCode: 303531797
CountryCode: US
TelephoneNumber: 7048342450
FaxNumber: 7046715331
Practice Location
Address1: 120 S MOUNTAIN ST
Address2:  
City: CHERRYVILLE
State: NC
PostalCode: 280213421
CountryCode: US
TelephoneNumber: 7044450422
FaxNumber: 7046717463
Other Information
ProviderEnumerationDate: 05/12/2017
LastUpdateDate: 05/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X188313NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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