Healthcare Provider Details

I. General information

NPI: 1851629158
Provider Name (Legal Business Name): KRISTIN BLACKWELL ROBINSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10628 PARK RD
CHARLOTTE NC
28210-8407
US

IV. Provider business mailing address

181 MILL POND RD
LAKE WYLIE SC
29710-6033
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-1971
  • Fax:
Mailing address:
  • Phone: 803-831-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number083104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: