MEDICARE: LEAH KATHERINE ROBINSON FNP

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	363LF0000X	Family Nurse Practitioner	AP128341	TX

General Provider Information

NPI Number	:	1417331844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH KATHERINE ROBINSON FNP

Provider Business Mailing Address
First Line	:	5308 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6293
Country	:	US
Telephone Number	:	817-993-6889
Fax Number	:	817-741-3575

Provider Business Practice Location Address
First Line	:	5308 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-993-6889
Fax Number	:	817-741-3575

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

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	06/04/2018

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