Provider Demographics
NPI:1356569156
Name:ROBINSON, CONNIE LYNN (RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:A
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:400 LOHRIG RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-9087
Mailing Address - Country:US
Mailing Address - Phone:731-427-0137
Mailing Address - Fax:
Practice Address - Street 1:804 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-927-8540
Practice Address - Fax:731-927-8600
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000044435163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448133Medicaid
TN4448133Medicaid
TN4448133Medicaid
3914083Medicare PIN