Provider Demographics
NPI:1730415183
Name:GIVENS, ROBYN RACHELLE (N P)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:RACHELLE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 LINDBERG DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8083
Mailing Address - Country:US
Mailing Address - Phone:985-326-8614
Mailing Address - Fax:985-445-1603
Practice Address - Street 1:1570 LINDBERG DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-326-8614
Practice Address - Fax:985-445-1603
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN108989-AP05968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2110683Medicaid
MS05158821Medicaid
MS05158821Medicaid