Healthcare Provider Details

I. General information

NPI: 1205265295
Provider Name (Legal Business Name): SHANNON HORTON ROBERTSON APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12090 S HARRELLS FERRY RD STE G
BATON ROUGE LA
70816-2470
US

IV. Provider business mailing address

12327 HAVEN AVE
BATON ROUGE LA
70818-5736
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-2020
  • Fax:
Mailing address:
  • Phone: 225-773-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number234773
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: