Healthcare Provider Details

I. General information

NPI: 1528172103
Provider Name (Legal Business Name): NAN ROBERTS RN, AP/MHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MEXICO RD STE 8
SAINT PETERS MO
63376-1667
US

IV. Provider business mailing address

5700 MEXICO RD STE 8
SAINT PETERS MO
63376-1667
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-6464
  • Fax: 636-410-9291
Mailing address:
  • Phone: 636-477-6464
  • Fax: 636-410-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number078206
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number078206
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: