Healthcare Provider Details

I. General information

NPI: 1629711726
Provider Name (Legal Business Name): KYLE ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 REBECCA DR
PALMYRA VA
22963-6242
US

IV. Provider business mailing address

33 REBECCA DR
PALMYRA VA
22963-6242
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-4680
  • Fax: 844-307-2857
Mailing address:
  • Phone: 434-654-4680
  • Fax: 844-307-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA199690
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101289806
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: