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General NPI Number Information
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NPI Number | 1437612801
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Entity Type | Individual
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Provider Name | REVA MATTHIEW ROBINSON MBA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 01/13/2024
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Provider Practice Location Address
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Address Line | 505 E TRAVIS ST
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City | MARSHALL
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State | TX
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Zip | 75670-4258
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Country | US
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Telephone | 281-223-6191
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5454
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City | SHREVEPORT
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State | LA
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Zip | 71135-5454
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Country | US
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Telephone | 318-218-5543
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Fax | 318-625-0638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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