Provider Demographics
NPI:1912867185
Name:IRYUMUGABE, ROBERT (BSN,RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:IRYUMUGABE
Suffix:
Gender:M
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 KY 146
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8700
Mailing Address - Country:US
Mailing Address - Phone:502-762-4669
Mailing Address - Fax:
Practice Address - Street 1:6460 KY 146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8700
Practice Address - Country:US
Practice Address - Phone:502-762-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Single Specialty