Healthcare Provider Details

I. General information

NPI: 1851719652
Provider Name (Legal Business Name): ROBREKA KING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BLVD SUITE #200-B
BATON ROUGE LA
70806-3743
US

IV. Provider business mailing address

8490 PICARDY AVE SUITE #200
BATON ROUGE LA
70809-3731
US

V. Phone/Fax

Practice location:
  • Phone: 225-381-2615
  • Fax: 225-383-8477
Mailing address:
  • Phone: 225-237-1754
  • Fax: 225-237-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP07105
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: