Provider Demographics
NPI:1790906436
Name:ROBBINS, MICHAEL R (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5702
Mailing Address - Country:US
Mailing Address - Phone:318-807-6258
Mailing Address - Fax:318-812-7347
Practice Address - Street 1:920 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-807-6258
Practice Address - Fax:318-812-7347
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012613363LP0808X
LA225852363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2593536Medicaid
TN3441136Medicaid