Provider Demographics
NPI:1043873698
Name:ROBINSON, LUCKY (APRN, AGPC-NP-C)
Entity type:Individual
Prefix:
First Name:LUCKY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:APRN, AGPC-NP-C
Other - Prefix:
Other - First Name:LUCKY
Other - Middle Name:
Other - Last Name:KEONAVONG-ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, AGPC-NP-C
Mailing Address - Street 1:3501 RICE ST STE 2020
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1757
Mailing Address - Country:US
Mailing Address - Phone:808-378-2400
Mailing Address - Fax:866-783-9834
Practice Address - Street 1:3501 RICE ST STE 2020
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1757
Practice Address - Country:US
Practice Address - Phone:808-378-2400
Practice Address - Fax:866-783-9834
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225067363LA2200X
HI3052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health