Provider Demographics
NPI:1083318711
Name:TULLIS, ROBIN R
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:TULLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 CINDY DR
Mailing Address - Street 2:
Mailing Address - City:LEDBETTER
Mailing Address - State:KY
Mailing Address - Zip Code:42058-9762
Mailing Address - Country:US
Mailing Address - Phone:618-926-1991
Mailing Address - Fax:
Practice Address - Street 1:466 CINDY DR
Practice Address - Street 2:
Practice Address - City:LEDBETTER
Practice Address - State:KY
Practice Address - Zip Code:42058-9762
Practice Address - Country:US
Practice Address - Phone:618-926-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker