Provider Demographics
NPI:1427594514
Name:EASON, ROBIN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:EASON
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 1:7474 SKILLMAN ST
Mailing Address - Street 2:APT.706
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8322
Mailing Address - Country:US
Mailing Address - Phone:214-213-4175
Mailing Address - Fax:214-579-9425
Practice Address - Street 1:7474 SKILLMAN ST.
Practice Address - Street 2:APT. 706
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-213-4175
Practice Address - Fax:214-579-9425
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0250620170251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0250620170Medicaid
TX0250620170Medicaid
TX0250620170Medicare NSC