Provider Demographics
NPI:1093090649
Name:ROBINSON, KAUANNA J
Entity Type:Individual
Prefix:
First Name:KAUANNA
Middle Name:J
Last Name:ROBINSON
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 1:10106 TECHNOLOGY BLVD WEST
Mailing Address - Street 2:722
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220
Mailing Address - Country:US
Mailing Address - Phone:469-826-5446
Mailing Address - Fax:
Practice Address - Street 1:10106 TECHNOLOGY BLVD W
Practice Address - Street 2:722
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4352
Practice Address - Country:US
Practice Address - Phone:469-826-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide