Provider Demographics
NPI:1407884547
Name:ROBBINS, MARY JO (FNP)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4078
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:375-C COURT STREET
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-0516
Practice Address - Country:US
Practice Address - Phone:423-733-2121
Practice Address - Fax:423-733-4563
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN005259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4046507OtherBLUECROSSBLUESHIELD
TN3901058Medicaid
TNTN01J5OtherJOHN DEERE
TNS68396Medicare UPIN
TN3901058Medicaid
TN3901059Medicare PIN