Healthcare Provider Details

I. General information

NPI: 1811044233
Provider Name (Legal Business Name): MICHELE ANN ROBERTS, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13612 BIG BEND RD
VALLEY PARK MO
63088-1447
US

IV. Provider business mailing address

PO BOX 323
BALLWIN MO
63022-0323
US

V. Phone/Fax

Practice location:
  • Phone: 314-578-2100
  • Fax: 636-333-4510
Mailing address:
  • Phone: 314-578-2100
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELE A ROBERTS
Title or Position: OWNER
Credential: CNP
Phone: 314-578-2100