Healthcare Provider Details

I. General information

NPI: 1659293108
Provider Name (Legal Business Name): KWANDALEISHA MIKILYN ROBERTS MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 JOHNSTON ST STE 205
LAFAYETTE LA
70503-5345
US

IV. Provider business mailing address

PO BOX 474
PORT BARRE LA
70577-0474
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone: 337-418-9915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number207087
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: