Healthcare Provider Details

I. General information

NPI: 1992350565
Provider Name (Legal Business Name): ROBYN MASSEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN GERBER

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 FOREST PARK AVE
SAINT LOUIS MO
63108-2806
US

IV. Provider business mailing address

139 WINDJAMMER LN
WILDWOOD MO
63040-1628
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-7333
  • Fax:
Mailing address:
  • Phone: 314-562-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2014040553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: