=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699083444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALMTREE PSYCHIATRIC MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2010
-----------------------------------------------------
Last Update Date | 04/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8235 YMCA PLAZA DR SUITE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70810-0939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-769-2441
-----------------------------------------------------
Fax | 225-769-2441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11078 SAVOY RD
-----------------------------------------------------
City | SAINT AMANT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70774-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-892-2784
-----------------------------------------------------
Fax | 337-643-8407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APMHNP
-----------------------------------------------------
Name | JEANENE TOOMBS ROBB
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 225-892-2784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP05977
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------