Provider Demographics
NPI:1588234207
Name:STEVERSON, ROBERT COLBY (SRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:COLBY
Last Name:STEVERSON
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PRUITT FARM RD
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-5030
Mailing Address - Country:US
Mailing Address - Phone:334-301-0322
Mailing Address - Fax:
Practice Address - Street 1:153 PRUITT FARM RD
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-5030
Practice Address - Country:US
Practice Address - Phone:334-301-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL1-160161367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program