1508183203 NPI number — MRS. MELISSA JILL ROBINSON MSPS, LBP

Table of content: MRS. MELISSA JILL ROBINSON MSPS, LBP (NPI 1508183203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508183203 NPI number — MRS. MELISSA JILL ROBINSON MSPS, LBP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
MELISSA
Provider Middle Name:
JILL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPS, LBP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
JILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPS, LBP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508183203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 ARLINGTON ST STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820-4072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-332-6851
Provider Business Mailing Address Fax Number:
580-310-6047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 ARLINGTON ST STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820-4072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-332-6851
Provider Business Practice Location Address Fax Number:
580-310-6047
Provider Enumeration Date:
04/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0330 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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