Provider Demographics
NPI:1841614823
Name:GILLHAM, ROBYN
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:GILLHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26509 HALE LN
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932-2399
Mailing Address - Country:US
Mailing Address - Phone:918-654-3274
Mailing Address - Fax:
Practice Address - Street 1:26509 HALE LN
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:OK
Practice Address - Zip Code:74932-2399
Practice Address - Country:US
Practice Address - Phone:918-654-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator