Healthcare Provider Details

I. General information

NPI: 1710512629
Provider Name (Legal Business Name): DEANDRA ROBINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

2700 OLD ROSEBUD RD STE 330
LEXINGTON KY
40509-8630
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6500
  • Fax: 606-783-6598
Mailing address:
  • Phone: 859-523-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2581
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: