Provider Demographics
NPI:1437565520
Name:LEOCATA, JACLYN N (RD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:LEOCATA
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 1:5212 W VILLAGE PKWY STE NO1
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8104
Mailing Address - Country:US
Mailing Address - Phone:479-308-8242
Mailing Address - Fax:800-820-0434
Practice Address - Street 1:5212 W VILLAGE PKWY STE NO1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8104
Practice Address - Country:US
Practice Address - Phone:479-308-8242
Practice Address - Fax:800-820-0434
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered