MR. TIMOTHY MALCOM ROBERTSON (NPI# 1790290047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790290047 |
| Entity Type | Individual |
| Full Name | MR. TIMOTHY MALCOM ROBERTSON |
| Credential | PCA |
| Practice Address |
184 Blacklog Road Fort Gay WV 25514 |
| Practice Telephone | 3042726671 |
| Mailing Telephone | 3043564562 |
| Mailing Fax Number | 3045584563 |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747P1801X |
Technician Specialization: Personal Care Attendant |
Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PROVIDER ID | 3810027474 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538415583 | Timothy Wayne Robertson Jr. | Physician Assistant | 4427 N Vineyard Meadow Ln, Katy, TX 77449-3445 | 2012-07-27 |
| 1255365300 | Timothy Wayne Robertson | Optometrist | 400 Solano St, Corning, CA 96021-3433 | 2006-07-11 |
| 1720067432 | Timothy Scot Robertson | Emergency Medicine | 26 Spring Basket Trl, The Woodlands, TX 77389 | 2006-01-11 |
| 1154328151 | Timothy Walter Robertson | Pharmacist | 10150 Brook Rd, Glen Allen, VA 23059-6514 | 2005-07-05 |
| 1750809067 | Timothy Dalton Robertson | Student in an Organized Health Care Education/Training Program | 718 Magnolia Dr, Tuscaloosa, AL 35487-0001 | 2017-09-07 |
| 1407282932 | Timothy Ross Robertson | Counselor | 3940 E 56th St, Indianapolis, IN 46220-5963 | 2013-09-16 |
| 1346440120 | Timothy Luke Robertson | Speech-Language Pathologist | 600 N. Main, Leeton, MO 64761 | 2007-07-20 |
| 1356375034 | Timothy L Robertson | Nurse Practitioner | 1400 Coulter, Amarillo, TX 79106 | 2006-07-10 |
| 1144270299 | Timothy John Robertson | Psychiatry & Neurology | 1400 Bellinger St, Eau Claire, WI 54703-5222 | 2006-05-11 |
| Street Address |
184 BLACKLOG ROAD |
| City | FORT GAY |
| State | WV |
| Zip Code | 25514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508353236 | Rebecca Jean Robertson | Technician | 184 Blacklog Road, Fort Gay, WV 25514 | 2018-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336816 | Sherry Lynn Marcum | Technician | Meeting House Branch Road, Fort Gay, WV 25514 | 2020-11-02 |
| 1558960377 | Anna Lynn Garn | Technician | 8702 Vancouver Street, Fort Gay, WV 25514 | 2020-10-22 |
| 1790382521 | Shasta Rachelle Sisk | Technician | 609 Spruce Creek Road, Fort Gay, WV 25514 | 2020-10-05 |
| 1992310536 | Karen Jean Minney | Technician | 687 Webb Branch Road, Fort Gay, WV 25514 | 2020-09-10 |
| 1679188429 | Polly Edna Robertson | Technician | 297 Orchard Street, Fort Gay, WV 25514 | 2020-09-09 |
| 1659984821 | Jennifer Dolly Marcum | Technician | 435 Big Sandy Road, Fort Gay, WV 25514 | 2020-08-27 |
| 1952914442 | Stephanie Thompson | Technician | 22786 Rte. 52, Fort Gay, WV 25514 | 2020-08-25 |
| 1053924548 | Marina Gail Jude | Technician | 112 James Ferguson Cemetery Roadd, Fort Gay, WV 25514 | 2020-08-25 |
| 1093220345 | Loretta Robertson | Technician | 302 Blacklog Rd, Fort Gay, WV 25514 | 2017-12-08 |
| 1346755691 | Alena Rae Wallace | Technician | 243 Blacklog Road, Fort Gay, WV 25514 | 2017-12-08 |
| Find all providers in zip 25514 | ||||
| Taxonomy Code | 3747P1801X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Personal Care Attendant |
| An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Notes: [7/1/2003: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336816 | Sherry Lynn Marcum | Technician | Meeting House Branch Road, Fort Gay, WV 25514 | 2020-11-02 |
| 1265032460 | Amber Richeal Webb | Technician | 260 Lower Right Fork Rd, Fort Gay, WV 25514-8087 | 2020-10-27 |
| 1558960377 | Anna Lynn Garn | Technician | 8702 Vancouver Street, Fort Gay, WV 25514 | 2020-10-22 |
| 1932708997 | Michelle Leigh Williams | Technician | 115 Ezekiel Ln, Fort Gay, WV 25514-7061 | 2020-10-21 |
| 1760089403 | Tammy Paulson | Technician | 125 Hayes Dr, Fort Gay, WV 25514-7416 | 2020-10-06 |
| 1790382521 | Shasta Rachelle Sisk | Technician | 609 Spruce Creek Road, Fort Gay, WV 25514 | 2020-10-05 |
| 1043825433 | Sylva Ladawn Blackburn | Technician | 274 Laura Fork Rd, Fort Gay, WV 25514-8020 | 2020-09-11 |
| 1992310536 | Karen Jean Minney | Technician | 687 Webb Branch Road, Fort Gay, WV 25514 | 2020-09-10 |
| 1619582475 | Rhonda Sue Thompson | Technician | 160 Laurel Fork, Fort Gay, WV 25517 | 2020-09-09 |
| 1891300711 | Laura Lea Williams | Technician | 30 Poplar Lick Rd, Fort Gay, WV 25514-8050 | 2020-09-09 |
| Find all providers in FORT GAY | ||||
Please comment or provide details below to improve the information on MR. TIMOTHY MALCOM ROBERTSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.