MEDICARE: KATHLEEN ROBLYER APRN PMHNP LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP120293	TX

General Provider Information

NPI Number	:	1477966034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN ROBLYER APRN PMHNP LLC

Provider Business Mailing Address
First Line	:	2151 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 113
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5281
Country	:	US
Telephone Number	:	979-693-0854
Fax Number	:	979-693-0863

Provider Business Practice Location Address
First Line	:	2151 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 113
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5281
Country	:	US
Telephone Number	:	979-693-0854
Fax Number	:	979-693-0863

Authorized Official
Title or Position	:	PMHNP
Name	:	DR. KATHLEEN AC ROBLYER
Credential	:	DMIN MSN APRN PMHNP
Telephone Number	:	979-693-0854

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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