Provider Demographics
NPI:1891969531
Name:ROBERTS, STACEY AMY (RD, LD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:AMY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6000
Mailing Address - Fax:
Practice Address - Street 1:131 FM 3168
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3605
Practice Address - Country:US
Practice Address - Phone:956-689-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00981966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered