Provider Demographics
NPI:1912388166
Name:ROBERTS, NATALIE (MS,RDN,LD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS,RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N RATHER ST
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5059
Mailing Address - Country:US
Mailing Address - Phone:903-312-6882
Mailing Address - Fax:
Practice Address - Street 1:405 N RATHER ST
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757-5059
Practice Address - Country:US
Practice Address - Phone:903-312-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06135133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered