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General NPI Number Information
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NPI Number | 1891336111
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Entity Type | Individual
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Provider Name | LARRY HUGH ROBERTSON II APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 55 DONOHOE DR
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City | HUNTINGTON
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State | WV
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Zip | 25705-8887
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Country | US
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Telephone | 304-525-7851
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Fax |
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Provider Business Mailing Address
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Address Line | 99 CRACKER BARREL DR STE 100
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1650
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Country | US
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Telephone | 304-525-7851
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Fax | 304-697-1251
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 104731
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 104731
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License Number State | WV
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