Provider Demographics
NPI:1659065019
Name:ROBINSON, KREYMOHNEY DESIREE (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:KREYMOHNEY
Middle Name:DESIREE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:LUNA PIER
Mailing Address - State:MI
Mailing Address - Zip Code:48157-0397
Mailing Address - Country:US
Mailing Address - Phone:734-353-7197
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST STE 101
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5374
Practice Address - Country:US
Practice Address - Phone:734-353-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier