Provider Demographics
NPI:1720246952
Name:CARSON, ROBIN SIMPSON (AUD)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SIMPSON
Last Name:CARSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4835
Mailing Address - Country:US
Mailing Address - Phone:817-737-4327
Mailing Address - Fax:817-737-4328
Practice Address - Street 1:5104 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4835
Practice Address - Country:US
Practice Address - Phone:817-737-4327
Practice Address - Fax:817-737-4328
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80063237600000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128760Medicare PIN
TX285327Medicare PIN