MEDICARE: MRS. SHANNON HORTON ROBERTSON APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	234773	LA

General Provider Information

NPI Number	:	1205265295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON HORTON ROBERTSON APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	12327 HAVEN AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-5736
Country	:	US
Telephone Number	:	225-773-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	12090 S HARRELLS FERRY RD STE G
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2470
Country	:	US
Telephone Number	:	985-333-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	06/30/2025

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