Healthcare Provider Details

I. General information

NPI: 1134820137
Provider Name (Legal Business Name): KYRA ELYSE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 MEMORIAL PKWY SW STE 5
HUNTSVILLE AL
35801-5035
US

IV. Provider business mailing address

182 WATER OAK DR
MADISON AL
35758-8308
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-9300
  • Fax:
Mailing address:
  • Phone: 919-601-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1201274
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: