Healthcare Provider Details

I. General information

NPI: 1629324355
Provider Name (Legal Business Name): ROBERTSON HEALTH CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 WALNUT ST
MONROE LA
71201-6229
US

IV. Provider business mailing address

513 WALNUT ST
MONROE LA
71201-6229
US

V. Phone/Fax

Practice location:
  • Phone: 318-372-2707
  • Fax: 318-323-2221
Mailing address:
  • Phone: 318-372-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP06545
License Number StateLA

VIII. Authorized Official

Name: AMBER A ROBERTSON
Title or Position: OWNER/OPERATOR
Credential: AFNP
Phone: 318-372-2707