Healthcare Provider Details

I. General information

NPI: 1700641214
Provider Name (Legal Business Name): LORENA ROBISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10108 BUNCOMB RD
BETHANY LA
71007-9514
US

IV. Provider business mailing address

10108 BUNCOMB RD
BETHANY LA
71007-9514
US

V. Phone/Fax

Practice location:
  • Phone: 318-840-3474
  • Fax:
Mailing address:
  • Phone: 318-840-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number082160
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: