Provider Demographics
NPI:1407144611
Name:ANDERSON, SONYA JENICE (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:JENICE
Last Name:ANDERSON
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 1:17 TYLER COVE
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7833
Mailing Address - Country:US
Mailing Address - Phone:870-489-5167
Mailing Address - Fax:
Practice Address - Street 1:1120 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7319
Practice Address - Country:US
Practice Address - Phone:501-207-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered