Provider Demographics
NPI:1447545645
Name:ROBINSON, KRISTEN LYN (PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 S HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7165
Mailing Address - Country:US
Mailing Address - Phone:704-840-5623
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:202 E EARLL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2634
Practice Address - Country:US
Practice Address - Phone:602-808-2800
Practice Address - Fax:602-808-2799
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4084207Q00000X
AZAP8992363LP0808X
NC5019414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624597Medicaid
AZ624597Medicaid