=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891289831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICE EDWARDS ROBINSON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2018
-----------------------------------------------------
Last Update Date | 06/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WILDCAT DRIVE
-----------------------------------------------------
City | RESERVE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-536-6492
-----------------------------------------------------
Fax | 985-536-6494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4013 N DELLS ST
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-432-5038
-----------------------------------------------------
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 | AP10072
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------