Provider Demographics
NPI:1891289831
Name:ROBINSON, PATRICE EDWARDS (NP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:EDWARDS
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:ELIZABETH
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4013 N DELLS ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2105
Mailing Address - Country:US
Mailing Address - Phone:504-432-5038
Mailing Address - Fax:
Practice Address - Street 1:1 WILDCAT DRIVE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084
Practice Address - Country:US
Practice Address - Phone:985-536-6492
Practice Address - Fax:985-536-6494
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2486721Medicaid