Provider Demographics
NPI:1346280476
Name:ROBINSON, KELLEY NICOLE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:NICOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 420
Mailing Address - Street 2:
Mailing Address - City:HAURE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078
Mailing Address - Country:US
Mailing Address - Phone:410-939-3121
Mailing Address - Fax:410-939-8278
Practice Address - Street 1:520 UPPER CHESAPEAKE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-939-3121
Practice Address - Fax:410-939-8278
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000251367A00000X
MDR174632367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004240941Medicaid
CT004240941Medicaid