Basic Information
| Provider Information | |||||||||
| NPI: | 1417409046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACK | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 MEDICAL CENTER DR SW | ||||||||
| Address2: | |||||||||
| City: | FORT PAYNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359683421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568997585 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1111 WAYNE RD NW | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358063567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562883333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1-121760 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LF0000X | 1-121760 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.