Provider Demographics
NPI:1689361974
Name:PRESTON, ROBERT ALAN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:PRESTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:
Practice Address - Street 1:1169 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2644
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-45192-052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse