Provider Demographics
NPI:1932542644
Name:ROBERTS, KRISTINE (RDN/LD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 CLIFFSIDE AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9589
Mailing Address - Country:US
Mailing Address - Phone:330-844-8743
Mailing Address - Fax:
Practice Address - Street 1:6578 CLIFFSIDE AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9589
Practice Address - Country:US
Practice Address - Phone:330-844-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH707831OtherREGISTRATION-DIETITIAN
OH1070OtherLICENSE-DIETITIAN