Provider Demographics
NPI:1710546205
Name:ROBINSON, WANDA LYNN (PHD, APRN, PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:LYNN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD, APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3703
Mailing Address - Country:US
Mailing Address - Phone:405-623-2840
Mailing Address - Fax:
Practice Address - Street 1:1100 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1200
Practice Address - Country:US
Practice Address - Phone:405-271-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO46347364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult