Healthcare Provider Details

I. General information

NPI: 1962756171
Provider Name (Legal Business Name): ROBIN JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 BLUE RIBBON DR
CATLETTSBURG KY
41129-8395
US

IV. Provider business mailing address

4437 BLUE RIBBON DR
CATLETTSBURG KY
41129-8395
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-4259
  • Fax:
Mailing address:
  • Phone: 606-928-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberW91-123-171
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberW91-123-171
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: