Provider Demographics
NPI:1386854883
Name:MEREDITH, ALICIA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:MEREDITH
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 1:3025 HIGHWAY 5 N LOT 111
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-6644
Mailing Address - Country:US
Mailing Address - Phone:501-847-9523
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3725
Practice Address - Country:US
Practice Address - Phone:501-776-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1235111071OtherHOSPITAL NPI NUMBER
AR1235111071OtherHOSPITAL NPI NUMBER