Provider Demographics
NPI:1568499523
Name:KYZER, HOLLY LEIGH (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LEIGH
Last Name:KYZER
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 1:840 HIGHWAY 222
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-7079
Mailing Address - Country:US
Mailing Address - Phone:501-384-5407
Mailing Address - Fax:
Practice Address - Street 1:BAPTIST HEALTH MEDICAL CENTER-ARKADELPHIA
Practice Address - Street 2:3050 TWIN RIVERS DR.
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923
Practice Address - Country:US
Practice Address - Phone:870-245-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR750133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X264OtherMNT PROVIDER