1114911138 NPI number — MS. JANE AUDREY GRAF ROBISON APRN, ARNP, BC-FNP

Table of content: MS. JANE AUDREY GRAF ROBISON APRN, ARNP, BC-FNP (NPI 1114911138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114911138 NPI number — MS. JANE AUDREY GRAF ROBISON APRN, ARNP, BC-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBISON
Provider First Name:
JANE
Provider Middle Name:
AUDREY GRAF
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, ARNP, BC-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114911138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 PICKENS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37040-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-645-5397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37040-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-648-2444
Provider Business Practice Location Address Fax Number:
931-572-1538
Provider Enumeration Date:
09/06/2005

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: 363LF0000X , with the licence number:  APN0000005854 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 02414P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: A630 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00890031 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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