Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3005204 | KY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 5204P | KY |
NPI | 1003008095 |
---|---|
Provider Name | Robin R House |
First Address | London, KY 40743-0936 |
Second Address | London, KY 40741-1688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000609854 | ANTHEM (01) | KY |
7100038230 | (05) | KY |
P00716443 | RR MEDICARE (01) | KY |