Individual
KENNETH ANDRE ROBERTS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, RD, LDN
Contact information
Practice address
922A TALON DR, O FALLON, IL 62269-1848
(618) 688-2038
Mailing address
922A TALON DR, O FALLON, IL 62269-1848
(618) 671-6501
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.007826
IL
133V00000X
Registered Dietitian
2019029751
MO
Other
Enumeration date
09/18/2019
Last updated
09/15/2021
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