Healthcare Provider Details

I. General information

NPI: 1659041994
Provider Name (Legal Business Name): ROBIN DUVALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

1301 SOUTHERN PKWY
CLARKSVILLE TN
37040-4340
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone: 417-217-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198365
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: