Provider Demographics
NPI:1205265295
Name:ROBERTSON, SHANNON HORTON (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:HORTON
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12327 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-5736
Mailing Address - Country:US
Mailing Address - Phone:225-773-1330
Mailing Address - Fax:
Practice Address - Street 1:153 N 17TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-3800
Practice Address - Country:US
Practice Address - Phone:985-333-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health