Healthcare Provider Details

I. General information

NPI: 1841916806
Provider Name (Legal Business Name): ANGELA CARR ROBINSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 07/02/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 WINTER ST
JACKSON MS
39204-2841
US

IV. Provider business mailing address

1134 WINTER ST
JACKSON MS
39204-2841
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-5572
  • Fax:
Mailing address:
  • Phone: 601-948-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number905656
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberROBI-QOT5J1
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: