Provider Demographics
NPI:1326746322
Name:HILLIS, MICHELLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HILLIS
Suffix:
Gender:F
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 1:203 PAMELA DR
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-1522
Mailing Address - Country:US
Mailing Address - Phone:501-772-5940
Mailing Address - Fax:
Practice Address - Street 1:203 PAMELA DR
Practice Address - Street 2:
Practice Address - City:ENGLAND
Practice Address - State:AR
Practice Address - Zip Code:72046-1522
Practice Address - Country:US
Practice Address - Phone:501-772-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered