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General NPI Number Information
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NPI Number | 1659293108
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Entity Type | Individual
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Provider Name | KWANDALEISHA MIKILYN ROBERTS MSN, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 5750 JOHNSTON ST STE 205
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City | LAFAYETTE
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State | LA
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Zip | 70503-5345
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 474
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City | PORT BARRE
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State | LA
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Zip | 70577-0474
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Country | US
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Telephone | 337-418-9915
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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 | 207087
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License Number State | LA
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