Provider Demographics
NPI:1114640752
Name:BAILEY, ALLISON GREY (MS, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GREY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:GREY
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:1701 S SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4335
Mailing Address - Country:US
Mailing Address - Phone:501-219-7998
Mailing Address - Fax:
Practice Address - Street 1:1701 S SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4335
Practice Address - Country:US
Practice Address - Phone:501-219-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1010133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR973585OtherCOMMISSION DIETETIC REGISTRATION
AR1010OtherAR LICENSE #