Individual
MICHELE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
368 WESTGLEN VILLAGE DR, BALLWIN, MO 63021-6134
(366) 289-6655
Mailing address
PO BOX 323, BALLWIN, MO 63022-0323
(314) 289-6655
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
103362
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428953418
—
MO
01
—
500028069
RAILROAD MEDICARE
MO
Enumeration date
07/19/2005
Last updated
01/09/2025
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