Provider Demographics
NPI:1508346644
Name:WILLIAMS, MOLLY (RDN/CSP/LD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDN/CSP/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PARKWAY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3116
Mailing Address - Country:US
Mailing Address - Phone:501-712-0301
Mailing Address - Fax:
Practice Address - Street 1:9300 COUNTS MASSIE RD
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7748
Practice Address - Country:US
Practice Address - Phone:501-712-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85506133VN1004X
AR2024133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric