Provider Demographics
NPI:1588727895
Name:DAWSON, ROBERT KEITH (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
Last Name:DAWSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:
Practice Address - Street 1:925 S NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-1874
Practice Address - Country:US
Practice Address - Phone:765-664-7492
Practice Address - Fax:765-664-4356
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001868A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200526080Medicaid
IN200526080Medicaid