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General NPI Number Information
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NPI Number | 1811635634
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Entity Type | Individual
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Provider Name | KASSIE OLIVIA ROBERTSON APN
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 2180 ADA AVE STE 300
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City | CONWAY
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State | AR
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Zip | 72034-4300
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Country | US
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Telephone | 501-327-6547
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Fax | 501-327-9715
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Provider Business Mailing Address
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Address Line | 2180 ADA AVE STE 300
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City | CONWAY
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State | AR
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Zip | 72034-4300
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Country | US
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Telephone | 501-327-6547
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Fax | 501-327-9715
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 220074
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License Number State | AR
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