Provider Demographics
NPI:1952901571
Name:ROBINSON, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BENJAMIN PKWY APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4617
Mailing Address - Country:US
Mailing Address - Phone:610-823-4872
Mailing Address - Fax:
Practice Address - Street 1:1510 BENJAMIN PKWY APT F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4617
Practice Address - Country:US
Practice Address - Phone:610-823-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000047205578172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver