Provider Demographics
NPI:1023460433
Name:BOBINMYER, ROBIN L (AGNP-C)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:BOBINMYER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-328-6501
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:201 S ARTHUR ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8400
Practice Address - Country:US
Practice Address - Phone:417-754-2223
Practice Address - Fax:417-754-8046
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019097363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO138880160Medicare Oscar/Certification