Provider Demographics
NPI:1083377931
Name:ROBERT, REBECCA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROBERT
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 MAPLE ST APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-4652
Mailing Address - Country:US
Mailing Address - Phone:504-355-7139
Mailing Address - Fax:
Practice Address - Street 1:809 MAPLE ST APT B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-4652
Practice Address - Country:US
Practice Address - Phone:504-355-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1861133V00000X
LA2910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered