Healthcare Provider Details

I. General information

NPI: 1134143332
Provider Name (Legal Business Name): ROBERT RAY ROBERTSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOB ROBERTSON APRN

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 N.E. LOOP 286 SUITE 2000
PARIS TX
75460-5085
US

IV. Provider business mailing address

PO BOX 6369
PARIS TX
75461-6245
US

V. Phone/Fax

Practice location:
  • Phone: 903-782-9500
  • Fax: 903-782-9550
Mailing address:
  • Phone: 903-782-9500
  • Fax: 903-782-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number569790
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: