Healthcare Provider Details

I. General information

NPI: 1235527144
Provider Name (Legal Business Name): LOUKISHA MONIQUE ROBERTS-HIGGENBOTHAM DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 W MAIN ST
SWAINSBORO GA
30401-3163
US

IV. Provider business mailing address

538 W COMMERCE ST STE 4350
DALLAS TX
75208-1921
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-2484
  • Fax: 478-237-7541
Mailing address:
  • Phone: 478-285-9950
  • Fax: 672-682-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN232719
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1034108
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN232719
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number285428
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: