Provider Demographics
NPI:1861655912
Name:MULKERN, DAWN MELTON (MBA, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MELTON
Last Name:MULKERN
Suffix:
Gender:F
Credentials:MBA, RD, LD
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:REBECCA
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, RD, LD
Mailing Address - Street 1:12 NINTH FAIRWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113
Mailing Address - Country:US
Mailing Address - Phone:501-551-1340
Mailing Address - Fax:
Practice Address - Street 1:12 NINTH FAIRWAY LOOP
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:501-551-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered