Provider Demographics
NPI:1295826352
Name:SCHICHTL, RACHEL ANN (RD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:SCHICHTL
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 1:28 BRYANT LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9615
Mailing Address - Country:US
Mailing Address - Phone:501-328-5682
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST # 120/LRVA
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6286
Practice Address - Fax:501-257-6291
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR893601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered