Provider Demographics
NPI:1902028723
Name:REYNOLDS, ROBIN (RD, LD, CDCES, CLT)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RD, LD, CDCES, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 HELENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1777
Mailing Address - Country:US
Mailing Address - Phone:501-246-1632
Mailing Address - Fax:844-364-2614
Practice Address - Street 1:9300 WHITE OAK CROSSING
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:501-777-8120
Practice Address - Fax:501-229-6070
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X597Medicare ID - Type UnspecifiedMNT PROVIDER - RD