Healthcare Provider Details

I. General information

NPI: 1578855722
Provider Name (Legal Business Name): JAMES RAY ROBINETTE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

IV. Provider business mailing address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-2069
  • Fax:
Mailing address:
  • Phone: 903-315-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12229-NA
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP128943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: