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General NPI Number Information
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NPI Number | 1225705056
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Entity Type | Individual
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Provider Name | RAE LYNNE ROBERTSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 08/28/2021
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Provider Practice Location Address
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Address Line | 1501 S POLK ST
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City | AMARILLO
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State | TX
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Zip | 79101-4228
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Country | US
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Telephone | 806-337-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5330 CLIFFSIDE CIR
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City | AMARILLO
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State | TX
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Zip | 79124-7917
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Country | US
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Telephone | 806-683-8054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1052582
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License Number State | TX
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