Healthcare Provider Details

I. General information

NPI: 1538236633
Provider Name (Legal Business Name): JESSICA GIBSON ROBIE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ONEIL ST
KINGSTON NY
12401-3510
US

IV. Provider business mailing address

70 ONEIL ST
KINGSTON NY
12401-3510
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-9506
  • Fax: 845-340-9509
Mailing address:
  • Phone: 845-340-9506
  • Fax: 845-340-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350088
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number719828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: