Provider Demographics
NPI:1518210012
Name:ROBINSON, JEANINE RAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:RAE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 HARPER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3373
Mailing Address - Country:US
Mailing Address - Phone:304-461-3879
Mailing Address - Fax:304-461-3848
Practice Address - Street 1:1717 HARPER RD
Practice Address - Street 2:SUITE A
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3373
Practice Address - Country:US
Practice Address - Phone:304-461-3879
Practice Address - Fax:304-461-3848
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1518210012Medicaid