Healthcare Provider Details

I. General information

NPI: 1306430285
Provider Name (Legal Business Name): STEPHANIE LUCILLE ROBINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

389 11TH AVE NE
GRAYSVILLE AL
35073-1012
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-1000
  • Fax:
Mailing address:
  • Phone: 334-695-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1773
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: