MEDICARE: MRS. KERNIE ROBIN 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	R197401	MD

General Provider Information

NPI Number	:	1881327500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERNIE ROBIN FNP

Provider Business Mailing Address
First Line	:	4408 LAVENDER LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4265
Country	:	US
Telephone Number	:	240-565-7769
Fax Number	:

Provider Business Practice Location Address
First Line	:	4408 LAVENDER LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4265
Country	:	US
Telephone Number	:	240-565-7769
Fax Number	:

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

Provider Enumeration Date	:	07/09/2022
Last Update Date	:	07/09/2022

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