Provider Demographics
NPI:1871143628
Name:ROBINSON, KELLY FAYE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:FAYE
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 1:2000 WESTBOROUGH DR APT 1013
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3283
Mailing Address - Country:US
Mailing Address - Phone:850-426-5742
Mailing Address - Fax:
Practice Address - Street 1:2000 WESTBOROUGH DR APT 1013
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3283
Practice Address - Country:US
Practice Address - Phone:850-426-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty