Provider Demographics
NPI:1104204270
Name:MCCARTHY, ERICK KEITH (RD, LD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:KEITH
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WATER OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3430
Mailing Address - Country:US
Mailing Address - Phone:501-733-7523
Mailing Address - Fax:
Practice Address - Street 1:18 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3430
Practice Address - Country:US
Practice Address - Phone:501-733-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1476133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered