Healthcare Provider Details

I. General information

NPI: 1215658489
Provider Name (Legal Business Name): ROBYN LYNN PUMMILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 QUICK SAND CIR
COLUMBIA MO
65202-3776
US

IV. Provider business mailing address

801 QUICK SAND CIR
COLUMBIA MO
65202-3776
US

V. Phone/Fax

Practice location:
  • Phone: 573-823-4765
  • Fax:
Mailing address:
  • Phone: 573-823-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number$$$$$$$$$
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: