Healthcare Provider Details

I. General information

NPI: 1669508263
Provider Name (Legal Business Name): MICHAEL C ROBERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 BAPTIST CIR STE 101
MADISON MS
39110-2028
US

IV. Provider business mailing address

455 CROSSGATES BLVD APT 232
BRANDON MS
39042-2560
US

V. Phone/Fax

Practice location:
  • Phone: 601-668-4938
  • Fax:
Mailing address:
  • Phone: 601-668-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR853495
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: