Provider Demographics
NPI:1316167570
Name:ROBERTSON, CATHY LYNN (APRN)
Entity type:Individual
Prefix:MISS
First Name:CATHY
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-221-0399
Mailing Address - Fax:318-221-1940
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:STE 201
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-221-0399
Practice Address - Fax:318-221-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094634 APO4253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily