Healthcare Provider Details

I. General information

NPI: 1922264225
Provider Name (Legal Business Name): BOB ROBERTSON, MNSC,RN,CS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/08/2014
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: ROBERT R ROBERTSON
Title or Position: CLINICAL NURSE SPECIALIST
Credential: MNSC
Phone: 903-782-9500