MEDICARE: BERNADETTE ROBERSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.200524	LA

General Provider Information

NPI Number	:	1063958981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE ROBERSON PA

Provider Business Mailing Address
First Line	:	7777 HENNESSY BLVD STE 301
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-0319
Country	:	US
Telephone Number	:	225-214-6436
Fax Number	:	225-214-6437

Provider Business Practice Location Address
First Line	:	7777 HENNESSY BLVD
Second Line	:	SUITE 301
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4300
Country	:	US
Telephone Number	:	225-214-6436
Fax Number	:	225-214-6437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	02/18/2026

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