Healthcare Provider Details

I. General information

NPI: 1760277784
Provider Name (Legal Business Name): NICOLE LOUISE ROBISON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 05/28/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6166 PREVATT RD
ASHFORD AL
36312-5231
US

IV. Provider business mailing address

6166 PREVATT RD
ASHFORD AL
36312-5231
US

V. Phone/Fax

Practice location:
  • Phone: 334-701-4910
  • Fax:
Mailing address:
  • Phone: 334-701-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-158878
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: