Healthcare Provider Details

I. General information

NPI: 1770564163
Provider Name (Legal Business Name): KRIS ANN ROBERTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/18/2025
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREVCO PLZ STE 101
LAKE SAINT LOUIS MO
63367-1382
US

IV. Provider business mailing address

PO BOX 7412119
CHICAGO IL
60674-2119
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5437
  • Fax: 636-561-5100
Mailing address:
  • Phone: 636-561-5437
  • Fax: 636-561-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013034100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: