Provider Demographics
NPI:1871126904
Name:ROBISON, STEPHANIE RENEE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7701 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7941
Mailing Address - Country:US
Mailing Address - Phone:806-202-1749
Mailing Address - Fax:
Practice Address - Street 1:7701 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7941
Practice Address - Country:US
Practice Address - Phone:806-202-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily