Provider Demographics
NPI:1033986161
Name:MELTON, ALLYSON KEELY (RD)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:KEELY
Last Name:MELTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 CYCLONE ST
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6641
Mailing Address - Country:US
Mailing Address - Phone:501-249-6796
Mailing Address - Fax:
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-673-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86359218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered