Provider Demographics
NPI:1609764422
Name:ROBERTS, NATHAN RYAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:RYAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SETTER LN
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-6311
Mailing Address - Country:US
Mailing Address - Phone:985-788-4899
Mailing Address - Fax:
Practice Address - Street 1:112 SETTER LN
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-6311
Practice Address - Country:US
Practice Address - Phone:985-788-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program