Provider Demographics
NPI:1801411285
Name:WORDEN, ALLYSON C (RD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:C
Last Name:WORDEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:D
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4117 LACY LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4306
Mailing Address - Country:US
Mailing Address - Phone:501-256-1048
Mailing Address - Fax:
Practice Address - Street 1:3724 JEFFERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6204
Practice Address - Country:US
Practice Address - Phone:512-693-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86148450133V00000X
TXDT89515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered