Provider Demographics
NPI:1134487887
Name:WINDER, TRACY (MS, RD/LD, CNSC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WINDER
Suffix:
Gender:F
Credentials:MS, RD/LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY
Mailing Address - Street 2:SLOT 603
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1278
Mailing Address - Fax:501-364-6819
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:SLOT 603
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1278
Practice Address - Fax:501-364-6819
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered