Healthcare Provider Details

I. General information

NPI: 1942897699
Provider Name (Legal Business Name): JUDY BROCKMANN ROBICHAUX PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD ATTN: JUDY ROBICHAUX-PEDIATRIC UNIT
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

1214 COOLIDGE BLVD ATTN: JUDY ROBICHAUX-PEDIATRIC UNIT
LAFAYETTE LA
70503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-4999
  • Fax: 337-289-7258
Mailing address:
  • Phone: 337-781-4999
  • Fax: 337-289-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPO3279
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: