Provider Demographics
NPI:1871103028
Name:ELLIOTT, ROBIN BROWN (PA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:BROWN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1515
Mailing Address - Country:US
Mailing Address - Phone:661-262-7479
Mailing Address - Fax:661-249-6881
Practice Address - Street 1:1 SAINT VINCENT CIR STE 120
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5406
Practice Address - Country:US
Practice Address - Phone:501-552-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13806207Q00000X
ARPA-9262083P0011X, 207Q00000X
ARPT2020-048363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical