Provider Demographics
NPI:1134438963
Name:ROBERTS, TRACY (MA, RDN, LDN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, RDN, LDN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FAYETTEVILLE VA MEDICAL CENTER - NUTRITION/FOOD SERVICE
Practice Address - Street 2:2300 RAMSEY STREET
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered