Provider Demographics
NPI:1366469702
Name:ROBINETTE, KERSTIN LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERSTIN
Middle Name:LEE
Last Name:ROBINETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1444
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-1444
Mailing Address - Country:US
Mailing Address - Phone:918-259-1118
Mailing Address - Fax:918-259-3507
Practice Address - Street 1:112 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8901
Practice Address - Country:US
Practice Address - Phone:918-259-1118
Practice Address - Fax:918-259-3507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100842830AMedicaid