Provider Demographics
NPI:1528172103
Name:ROBERTS, NAN (RN, AP/MHCNS)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, AP/MHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MEXICO RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1667
Mailing Address - Country:US
Mailing Address - Phone:636-477-6464
Mailing Address - Fax:636-410-9291
Practice Address - Street 1:5700 MEXICO RD STE 8
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1667
Practice Address - Country:US
Practice Address - Phone:636-477-6464
Practice Address - Fax:636-410-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO078206163WP0809X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult