Provider Demographics
NPI:1790083053
Name:COATES, ELIZABETH JEAN (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:COATES
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:AR
Mailing Address - Zip Code:71766-0006
Mailing Address - Country:US
Mailing Address - Phone:870-352-7949
Mailing Address - Fax:870-352-0289
Practice Address - Street 1:201 N CLIFTON ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3026
Practice Address - Country:US
Practice Address - Phone:870-352-7949
Practice Address - Fax:870-352-0289
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered