Healthcare Provider Details

I. General information

NPI: 1902899453
Provider Name (Legal Business Name): ROBIN JOY GRAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax: 573-443-0574
Mailing address:
  • Phone: 573-443-2402
  • Fax: 573-443-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number147292
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: