Healthcare Provider Details

I. General information

NPI: 1376972570
Provider Name (Legal Business Name): KELLI ROBERTSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 02/19/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79630 HIGHWAY LA 21
BUSH LA
70431
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-2252
  • Fax: 985-730-2258
Mailing address:
  • Phone: 225-526-0010
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07386
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: