Healthcare Provider Details

I. General information

NPI: 1639018955
Provider Name (Legal Business Name): ROBERT TIMOTHY MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 DOW DR
SHELBYVILLE TN
37160-2216
US

IV. Provider business mailing address

802 DOW DR
SHELBYVILLE TN
37160-2216
US

V. Phone/Fax

Practice location:
  • Phone: 931-619-6331
  • Fax:
Mailing address:
  • Phone: 931-619-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42539
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number262419
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: