1881205276 NPI number — TERRI LEWELLEN ROBINSON PA-C

Table of content: TERRI LEWELLEN ROBINSON PA-C (NPI 1881205276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881205276 NPI number — TERRI LEWELLEN ROBINSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
TERRI
Provider Middle Name:
LEWELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWELLEN
Provider Other First Name:
TERRI
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881205276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603949
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-3949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-498-4490
Provider Business Mailing Address Fax Number:
919-350-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 WESVILL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-2973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-571-1567
Provider Business Practice Location Address Fax Number:
919-782-1472
Provider Enumeration Date:
08/11/2020

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: 363A00000X , with the licence number:  0010-10299 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881205276 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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