Individual provider Active NPI

Robin Roush Wood, N.P.

  • Pediatric Nurse Practitioner
  • Bossier City, LA
National Provider Identifier
1194746818
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN098102 Issued in LA
Practice address
218 Shadow Ridge Dr
Bossier City, LA 71112-9736
Phone
(318) 746-2346
NPI assigned
Jul 21, 2006
Last updated
Nov 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN098102 LA Primary

Addresses

Primary practice location

218 Shadow Ridge Dr
Bossier City, LA 71112-9736

Mailing address

218 Shadow Ridge Dr
Bossier City, LA 71112-9736
Phone (318) 746-2346

Other identifiers 1

IdentifierTypeStateIssuer
1178063MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050210000608 LA Practitioner - Nurse Practitioner 4789636408 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN098102LAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Health Central Louisiana CurrentSince May 1, 2007 Accepting new patients
Christus Health Central Louisiana CurrentSince May 1, 2007 Accepting new patients
Christus Health Central Louisiana Past Accepting new patients

Locations

1633 Marvel St
Coushatta, LA 71019
Phone (318) 932-2081

1635 Marvel St
Coushatta, LA 71019
Phone (318) 932-2000

3342 Bienville Rd
Ringgold, LA 71068
Phone (318) 894-9611

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1194746818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 SHADOW RIDGE DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711129736",
            "telephone_number": "318-746-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 SHADOW RIDGE DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711129736",
            "telephone_number": "318-746-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "ROBIN",
        "middle_name": "ROUSH",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "LA",
            "license": "RN098102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1178063",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.