Healthcare Provider Details

I. General information

NPI: 1811193709
Provider Name (Legal Business Name): KIMBERLY ROBINSON SURGICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLE CHASSE HWY
TERRYTOWN LA
70056-7127
US

IV. Provider business mailing address

2724 BAYOU DES CANNES DR
MARRERO LA
70072-6572
US

V. Phone/Fax

Practice location:
  • Phone: 504-495-6647
  • Fax: 504-328-1343
Mailing address:
  • Phone: 504-495-6647
  • Fax: 504-328-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: