MEDICARE: DR. KENITH LEON ROBINS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	326632-2501	UT
2	103TC0700X	Clinical Psychologist	P0000002879	TN

General Provider Information

NPI Number	:	1417105792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENITH LEON ROBINS PHD

Provider Business Mailing Address
First Line	:	2611 SALEM CREEK DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37128-5587
Country	:	US
Telephone Number	:	615-310-1491
Fax Number	:	615-848-0337

Provider Business Practice Location Address
First Line	:	2611 SALEM CREEK DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37128-5587
Country	:	US
Telephone Number	:	615-310-1491
Fax Number	:	615-848-0337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	09/22/2021

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