Healthcare Provider Details

I. General information

NPI: 1114882776
Provider Name (Legal Business Name): DAVID LEE ROBERTSON PMHNP-BC, MSN, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 N HALL ST
DALLAS TX
75235-8846
US

IV. Provider business mailing address

5042 N HALL ST
DALLAS TX
75235-8846
US

V. Phone/Fax

Practice location:
  • Phone: 214-455-3017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number763920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: