Healthcare Provider Details

I. General information

NPI: 1255336418
Provider Name (Legal Business Name): KATHLEEN M ROBBINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 BAGNELL DAM BLVD STE 103
LAKE OZARK MO
65049-8603
US

IV. Provider business mailing address

PO BOX 1027
JEFFERSON CITY MO
65102-1027
US

V. Phone/Fax

Practice location:
  • Phone: 573-964-5599
  • Fax: 573-365-6011
Mailing address:
  • Phone: 573-761-7246
  • Fax: 573-761-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000145060
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: