Provider Demographics
NPI:1295966786
Name:ROBINSON, ABIGAIL K (PA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W RANDOLPH ST APT 2511
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3525
Mailing Address - Country:US
Mailing Address - Phone:817-715-7015
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7300
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06279363AM0700X
IL085005746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00743934OtherRAILROAD MEDICARE
TX342424YNGSOtherMEDICARE - TARRANT - NEW # 2013
TX342424YNGSOtherMEDICARE - TARRANT - NEW # 2013