Healthcare Provider Details

I. General information

NPI: 1417382433
Provider Name (Legal Business Name): ALLISON ROBERTSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NATIONWIDE DR SUITE A
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

401 YOUNGSVILLE HWY STE 100
LAFAYETTE LA
70508-5173
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1862
  • Fax:
Mailing address:
  • Phone: 337-205-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07523
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0024172975
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: