Provider Demographics
NPI:1740233402
Name:ROBINSON, TERESA RENEA (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:RENEA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:306 HOSPITAL DRIVE
Mailing Address - Street 2:STE 202C
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503
Mailing Address - Country:US
Mailing Address - Phone:606-237-5800
Mailing Address - Fax:606-237-5858
Practice Address - Street 1:306 HOSPITAL DRIVE
Practice Address - Street 2:STE 202C
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503
Practice Address - Country:US
Practice Address - Phone:606-237-5800
Practice Address - Fax:606-237-5858
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3567P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7104075000Medicaid
KY78006038Medicaid
P41966Medicare UPIN
KY0945801Medicare ID - Type Unspecified