Individual provider Active NPI

Tatonya Monique Roberts, FNP

  • Family Nurse Practitioner
  • Ballwin, MO
National Provider Identifier
1639603293
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017004145 Issued in MO
Practice address
14400 Clayton Rd
Ballwin, MO 63011-2713
Phone
(636) 207-1137
NPI assigned
Apr 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209015544 IL
Family Nurse Practitioner 363LF0000X 2017004145 MO Primary

Addresses

Primary practice location

14400 Clayton Rd
Ballwin, MO 63011-2713

Mailing address

14400 Clayton Rd
Ballwin, MO 63011-2713
Phone (636) 207-1137

Other identifiers 1

IdentifierTypeStateIssuer
F1116320OtherILAANP CERTIFICATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170929001628 IL Practitioner - Nurse Practitioner 5597030668
I20190128002802 MO Practitioner - Nurse Practitioner 5597030668 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Diagnostic of Kansas PAGroup PAC ID 7416043807, 139 clinicians

Practice addresses (Care Compare)

11560 Olive Blvd
Creve Coeur, MO 63141-7111
Phone (866) 389-2727

14400 Clayton Rd
Ballwin, MO 63011-2713
Phone (866) 389-2727

15846 Manchester Rd
Ellisville, MO 63011-2208
Phone (866) 389-2727

3002 Hwy K
O Fallon, MO 63368-8675
Phone (866) 389-2727

3825 S Noland Rd
Independence, MO 64055-3344
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic of Kansas PA Family CurrentSince Jun 27, 2024 Accepting new patients
SSM Health Care St Louis CurrentSince Mar 4, 2024 Accepting new patients
SSM Health Care St. Louis CurrentSince Mar 4, 2024 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

14400 Clayton Rd
Ballwin, MO 63011
Phone (636) 207-1137

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1120 Shackelford Rd
Florissant, MO 63031
Phone (314) 830-5805

3825 S Noland Rd
Independence, MO 64055
Phone (816) 254-6002

2022 Dorsett Vlg
Maryland Heights, MO 63043
Phone (314) 520-0520

8021 Watson Rd
Webster Groves, MO 63119
Phone (314) 963-0398

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1639603293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14400 CLAYTON RD",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112713",
            "telephone_number": "636-207-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14400 CLAYTON RD",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112713",
            "telephone_number": "636-207-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "TATONYA",
        "middle_name": "MONIQUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-20",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209015544",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017004145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANP CERTIFICATION",
            "identifier": "F1116320",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballwin, MO

Sources for this page

Verify at the official NPI Registry.