Individual provider Active NPI

Robin Lynne Gale, PNP

  • Pediatric Nurse Practitioner
  • Jefferson, TX
National Provider Identifier
1700870185
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
663506 Issued in TX
Practice address
219 N Polk St
Jefferson, TX 75657
Phone
(903) 665-2600
Fax
(903) 665-2608
NPI assigned
Aug 31, 2005
Last updated
Jul 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 663506 TX Primary

Addresses

Primary practice location

219 N Polk St
Jefferson, TX 75657

Mailing address

219 N Polk St
Jefferson, TX 75657
Phone (903) 665-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041018000863 TX Practitioner - Nurse Practitioner 4880654458 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Phynet, Inc. CurrentSince Oct 6, 2012 Accepting new patients
Phynet, Inc. Past Accepting new patients

Locations

307 W Upshur Ave
Gladewater, TX 75647
Phone (903) 845-2159

219 N Polk St
Jefferson, TX 75657
Phone (903) 665-2600

1711 S Henderson Blvd
Ste 300
Kilgore, TX 75662
Phone (903) 983-1578

402 N Kaufman St
Linden, TX 75563
Phone (903) 665-9500

4002 Technology Ctr
Longview, TX 75605
Phone (903) 247-0484

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AEADCA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1700870185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 N POLK ST",
            "city": "JEFFERSON",
            "state": "TX",
            "postal_code": "75657",
            "telephone_number": "903-665-2600",
            "fax_number": "903-665-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 N POLK ST",
            "city": "JEFFERSON",
            "state": "TX",
            "postal_code": "75657",
            "telephone_number": "903-665-2600",
            "fax_number": "903-665-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALE",
        "first_name": "ROBIN",
        "middle_name": "LYNNE",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "663506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, TX

Sources for this page

Verify at the official NPI Registry.