Provider Demographics
NPI:1689693954
Name:ROBINSON, CHERYL GUSTAVIS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:GUSTAVIS
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:WYNETTE
Other - Last Name:GUSTAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6013 HANGING MOSS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2120
Mailing Address - Country:US
Mailing Address - Phone:601-982-9325
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1327
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR597686163W00000X, 163WC0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management