Provider Demographics
NPI:1922004159
Name:MARTIN, ROBERT M (MS CFNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS CFNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11541 KINGSTON PIKE
Mailing Address - Street 2:STE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0000
Mailing Address - Country:US
Mailing Address - Phone:865-675-7522
Mailing Address - Fax:865-671-3196
Practice Address - Street 1:11541 KINGSTON PIKE
Practice Address - Street 2:STE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-0000
Practice Address - Country:US
Practice Address - Phone:865-675-7522
Practice Address - Fax:865-671-3196
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN7953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908484Medicaid
44D0993636OtherFED CLIA ID NUMBER
MM0617300OtherFED DEA #
MM0617300OtherFED DEA #
TNP19355Medicare UPIN