Provider Demographics
NPI:1700328994
Name:ROBERSON, SHELBY (RD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:PIERCEALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:1500 MUSEUM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4785
Practice Address - Country:US
Practice Address - Phone:501-932-9010
Practice Address - Fax:870-569-3579
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1623133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered