Healthcare Provider Details

I. General information

NPI: 1689662439
Provider Name (Legal Business Name): ROBERT ALLEN VARNADO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 STONEWALL DR
BATON ROUGE LA
70817-2549
US

IV. Provider business mailing address

5240 STONEWALL DR
BATON ROUGE LA
70817-2549
US

V. Phone/Fax

Practice location:
  • Phone: 225-756-1325
  • Fax: 225-753-4805
Mailing address:
  • Phone: 225-756-1325
  • Fax: 225-753-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN038204 AP038204
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: