Provider Demographics
NPI:1033726922
Name:LANDRY, ALICIA (PHD, RDN, LDN)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PHD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DONAGHEY AVE,
Mailing Address - Street 2:MCALISTER 100
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72035
Mailing Address - Country:US
Mailing Address - Phone:501-852-0230
Mailing Address - Fax:
Practice Address - Street 1:201 DONAGHEY AVE,
Practice Address - Street 2:MCALISTER 100
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035
Practice Address - Country:US
Practice Address - Phone:501-852-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1938133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered