Healthcare Provider Details

I. General information

NPI: 1376052365
Provider Name (Legal Business Name): ROBIN ALLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 KELLEY PKWY
MEXICO MO
65265-3811
US

IV. Provider business mailing address

340 KELLEY PKWY
MEXICO MO
65265-3811
US

V. Phone/Fax

Practice location:
  • Phone: 573-558-1234
  • Fax:
Mailing address:
  • Phone: 573-558-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017032884
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2017032884
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: