Provider Demographics
NPI:1215141296
Name:ROBERTS, PAUL BYRON (FNP-C, APN)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BYRON
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:FNP-C, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 DANNA ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292
Mailing Address - Country:US
Mailing Address - Phone:318-323-9433
Mailing Address - Fax:318-361-2680
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-323-9433
Practice Address - Fax:318-361-2680
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1784885Medicaid
LA4H570B110Medicare ID - Type Unspecified
LA1784885Medicaid