=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720807464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TALISHA DANEE ROBINSON MSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2024
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3404 KAYDENCE CT
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-3338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-499-8741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9601 ROGANO CT
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-6503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-863-0305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 819416
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------