Healthcare Provider Details

I. General information

NPI: 1376492942
Provider Name (Legal Business Name): AMARRI DESHAWN ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 MANCHESTER DR
VICKSBURG MS
39183-4407
US

IV. Provider business mailing address

253 MANCHESTER DR
VICKSBURG MS
39183-4407
US

V. Phone/Fax

Practice location:
  • Phone: 601-415-1007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908677
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: