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NPI Code Detail

MEDICARE: ROBIN SHECKLES

MEDICARE: ROBIN SHECKLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1169994KY

General Provider Information

NPI Number : 1104782028
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN SHECKLES
Provider Business Mailing Address
First Line : 2233 AMBOY DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-4334
Country : US
Telephone Number : 502-819-5170
Fax Number :
Provider Business Practice Location Address
First Line : 2233 AMBOY DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-4334
Country : US
Telephone Number : 502-819-5170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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