Provider Demographics
NPI:1508167867
Name:ROBINSON, TARA J (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:108 WASHINGTON ST W STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2344
Mailing Address - Country:US
Mailing Address - Phone:304-345-4525
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:108 WASHINGTON ST W STE 101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2344
Practice Address - Country:US
Practice Address - Phone:304-345-4525
Practice Address - Fax:304-345-4527
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1077207NS0135X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology