Healthcare Provider Details

I. General information

NPI: 1558434159
Provider Name (Legal Business Name): ROBIN LINCOLN SUMNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 W GRAND AVE
PORTERVILLE CA
93257-2071
US

IV. Provider business mailing address

PO BOX 90605
RALEIGH NC
27675-0605
US

V. Phone/Fax

Practice location:
  • Phone: 951-412-1540
  • Fax:
Mailing address:
  • Phone: 919-881-8295
  • Fax: 919-676-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number102542
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number62616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: