Provider Demographics
NPI:1689486219
Name:ROBINSON, KADARA L (MBA, BPS,AS, CCMA)
Entity type:Individual
Prefix:
First Name:KADARA
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MBA, BPS,AS, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3511
Mailing Address - Country:US
Mailing Address - Phone:662-537-8655
Mailing Address - Fax:
Practice Address - Street 1:4462 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3511
Practice Address - Country:US
Practice Address - Phone:662-537-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care