Healthcare Provider Details

I. General information

NPI: 1063653012
Provider Name (Legal Business Name): ROBIN RENEE MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

IV. Provider business mailing address

471 LAWRENCE ROAD 269
SMITHVILLE AR
72466-8015
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1200
  • Fax:
Mailing address:
  • Phone: 870-528-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR32493
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723886
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007031666
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: