Healthcare Provider Details

I. General information

NPI: 1972823359
Provider Name (Legal Business Name): CASSIE C ROBINSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 TININ DR
CORINTH MS
38834-9054
US

IV. Provider business mailing address

3301 TININ DR
CORINTH MS
38834-9054
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-9111
  • Fax: 662-665-9118
Mailing address:
  • Phone: 662-665-9111
  • Fax: 662-665-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR867782
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: