Healthcare Provider Details

I. General information

NPI: 1386047157
Provider Name (Legal Business Name): ROBIN SIKES DESVAUX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 09/25/2025
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S MAIN ST
MOUNT HOLLY NC
28120-1620
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-587-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007242
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: