Provider Demographics
NPI:1871742817
Name:ROBERTSON, GINA ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2084
Mailing Address - Country:US
Mailing Address - Phone:785-270-4630
Mailing Address - Fax:785-270-4628
Practice Address - Street 1:3707 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2084
Practice Address - Country:US
Practice Address - Phone:785-270-4630
Practice Address - Fax:785-270-4628
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74637364SP0810X, 363LP0808X
KS56529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200738650BMedicaid
KS100385900AMedicaid
KS200738650BMedicaid