Healthcare Provider Details

I. General information

NPI: 1215028584
Provider Name (Legal Business Name): BILLIE THAY ROBINSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S 17TH ST SUITE 1
WILMINGTON NC
28401-6626
US

IV. Provider business mailing address

1907 S 17TH ST SUITE 1
WILMINGTON NC
28401-6626
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax: 910-343-6989
Mailing address:
  • Phone: 910-343-8424
  • Fax: 910-343-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number190232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: