Healthcare Provider Details

I. General information

NPI: 1093627770
Provider Name (Legal Business Name): ROBIN KATINA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEYSHAUN BRAZZLE

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W WACO DR
WACO TX
76710-7033
US

IV. Provider business mailing address

4300 W WACO DR SUITE 2 BLDG B804
WACO TX
76710-7033
US

V. Phone/Fax

Practice location:
  • Phone: 254-723-1588
  • Fax:
Mailing address:
  • Phone: 254-723-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: