Healthcare Provider Details

I. General information

NPI: 1790432896
Provider Name (Legal Business Name): AIMEE A. ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

21196 LA HIGHWAY 444
LIVINGSTON LA
70754-5104
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number224349
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: