Provider Demographics
NPI:1477950434
Name:ROBINSON, WENDELL PERRY (APRN)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:PERRY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 GAUSE BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2942
Mailing Address - Country:US
Mailing Address - Phone:985-898-7420
Mailing Address - Fax:
Practice Address - Street 1:1051 GAUSE BLVD STE 480
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-898-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215666363LP0808X, 363LP0808X
MSR893115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse