Basic Information
Provider Information
NPI: 1003008095
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOUSE
FirstName: ROBIN
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: APRN NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 936
Address2:  
City: LONDON
State: KY
PostalCode: 407430936
CountryCode: US
TelephoneNumber: 6063307835
FaxNumber: 6063307825
Practice Location
Address1: 1406 W 5TH ST
Address2: SUITE 201
City: LONDON
State: KY
PostalCode: 407411688
CountryCode: US
TelephoneNumber: 6063302377
FaxNumber: 6063302369
Other Information
ProviderEnumerationDate: 08/14/2007
LastUpdateDate: 08/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3005204KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X5204PKYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
00000060985401KYANTHEMOTHER
710003823005KY MEDICAID
P0071644301KYRR MEDICAREOTHER


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