Healthcare Provider Details

I. General information

NPI: 1801546692
Provider Name (Legal Business Name): ROBIN GRANT PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/30/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH ST
KOTZEBUE AK
99752
US

IV. Provider business mailing address

436 5TH ST
KOTZEBUE AK
99752
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax: 617-344-3857
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP221394
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN68549
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2334521
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number237978
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: