Provider Demographics
NPI:1770891210
Name:ROBISON, DAVID A (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:ROBISON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-874-0707
Practice Address - Street 1:2721 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7491
Practice Address - Country:US
Practice Address - Phone:704-874-2255
Practice Address - Fax:704-810-7417
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4335363L00000X
NC5010071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCE1315OtherMEDICARE RAILROAD GROUP #
SCGP0641Medicaid
SC423876OtherRHC MEDICARE (INDIANLAND)
SCRHC127OtherRHC MEDICAID (LANCASTER)
SCRHC211OtherRHC MEDICAID (INDIANLAND)
SC428960OtherRHC MEDICARE (LANCASTER)
SCNP1692OtherMEDICAID INDIVIDUAL PROVIDER ID
SCCE1315OtherMEDICARE RAILROAD GROUP #
SCRHC127OtherRHC MEDICAID (LANCASTER)