MEDICARE: KORRY ANN ROBINSON

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902451644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORRY ANN ROBINSON

Provider Business Mailing Address
First Line	:	1256 RANGE VIEW CIR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2104
Country	:	US
Telephone Number	:	605-786-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CENTRE ST STE 100
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-3004
Country	:	US
Telephone Number	:	800-521-9604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	06/13/2024

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