Basic Information
| Provider Information | |||||||||
| NPI: | 1972558328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERSON-TRAMMELL | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40480 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366400480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514105437 | ||||||||
| FaxNumber: | 2514343802 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 CENTER ST | ||||||||
| Address2: | STE 1N | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514105437 | ||||||||
| FaxNumber: | 2514343802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 19407 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 51034793 | 01 | AL | BLUE CROSS | OTHER | 12-10138 | 01 | AL | UNITED HEALTH CARE | OTHER | 009929255 | 05 | AL | MEDICAID | 00120269 | 05 | MS | MEDICAID | 1414336 | 05 | LA | MEDICAID | 257537000 | 05 | FL | MEDICAID | 000034793 | 05 | AL | MEDICAID |