Provider Demographics
NPI:1710253877
Name:ROBINSON, CARLEY RENEE (CPNP)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:RENEE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CPNP
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 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-399-6100
Mailing Address - Fax:601-399-6281
Practice Address - Street 1:1203 AVE B
Practice Address - Street 2:STE 200
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2080
Practice Address - Country:US
Practice Address - Phone:601-477-3550
Practice Address - Fax:601-477-2236
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860565363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01787021Medicaid