Provider Demographics
NPI:1437334216
Name:VANDERFORD, ROBYN Y (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:Y
Last Name:VANDERFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ROBYN
Other - Middle Name:Y
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:115 S MUNFORD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2527
Mailing Address - Country:US
Mailing Address - Phone:901-244-4648
Mailing Address - Fax:901-244-4647
Practice Address - Street 1:899 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2568
Practice Address - Country:US
Practice Address - Phone:901-244-4646
Practice Address - Fax:901-244-4647
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013123363LF0000X
TN13123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021158Medicaid