Provider Demographics
NPI:1457523284
Name:RUBIN, NORMAN ZACHARY (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:ZACHARY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FM 1460 APT 2201
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-4463
Mailing Address - Country:US
Mailing Address - Phone:606-356-6040
Mailing Address - Fax:
Practice Address - Street 1:2000 FM 1460 APT 2201
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4463
Practice Address - Country:US
Practice Address - Phone:606-356-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1104521163W00000X
TX435970163W00000X
KY3005795363LP0808X
TXAP123171363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid
TXAP123171OtherLICENSE
TX3317273-02Medicaid
KY30610026Medicaid