=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861068447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA ROBERTSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2021
-----------------------------------------------------
Last Update Date | 11/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 395 S CAPITOL ST
-----------------------------------------------------
City | MANY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71449-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-527-3255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 395 S CAPITOL ST
-----------------------------------------------------
City | MANY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71449-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-256-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 220149
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 157605
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------