Healthcare Provider Details

I. General information

NPI: 1114370160
Provider Name (Legal Business Name): JOHNNIE ROBBINS RN, APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 301 ANDREWS AVE LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362-5333
US

IV. Provider business mailing address

BLDG 301 ANDREWS AVE LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362-5333
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-7409
  • Fax:
Mailing address:
  • Phone: 334-255-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number702864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: