Provider Demographics
NPI:1902528433
Name:ROBERTS, KRISTEN N (NTP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:N
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-3920
Mailing Address - Country:US
Mailing Address - Phone:860-227-0833
Mailing Address - Fax:
Practice Address - Street 1:250 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-3920
Practice Address - Country:US
Practice Address - Phone:860-227-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6226133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist