Provider Demographics
NPI:1467122309
Name:CONDREN FAMILY NUTRITION
Entity Type:Organization
Organization Name:CONDREN FAMILY NUTRITION
Other - Org Name:CONDREN FAMILY NUTRITION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONDREN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:501-779-8327
Mailing Address - Street 1:4 SHACKLEFORD PLZ STE 209
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1844
Mailing Address - Country:US
Mailing Address - Phone:501-779-8327
Mailing Address - Fax:501-500-5750
Practice Address - Street 1:4 SHACKLEFORD PLZ STE 209
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1844
Practice Address - Country:US
Practice Address - Phone:501-779-8327
Practice Address - Fax:501-500-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty