Provider Demographics
NPI:1063646867
Name:CALDWELL, JOLENE KAY (RD)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:KAY
Last Name:CALDWELL
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 1:2005 AIRPARK RD
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1806
Mailing Address - Country:US
Mailing Address - Phone:870-238-4344
Mailing Address - Fax:870-238-8937
Practice Address - Street 1:2005 AIRPARK RD
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-1806
Practice Address - Country:US
Practice Address - Phone:870-238-4344
Practice Address - Fax:870-238-8937
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR491710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R491710OtherREGISTERED DIETITAIN