Provider Demographics
NPI:1497162705
Name:ROBISON, DESIREE (NP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6971
Mailing Address - Country:US
Mailing Address - Phone:337-942-4453
Mailing Address - Fax:337-948-0900
Practice Address - Street 1:153 TOWN BLVD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6971
Practice Address - Country:US
Practice Address - Phone:337-942-4453
Practice Address - Fax:337-948-0900
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily