Provider Demographics
NPI:1023426327
Name:BYRUM, COURTNEY (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:BYRUM
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:CONDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 SHACKLEFORD PLZ STE 209
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1844
Mailing Address - Country:US
Mailing Address - Phone:501-779-8327
Mailing Address - Fax:501-500-5750
Practice Address - Street 1:4 SHACKLEFORD PLZ STE 209
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1844
Practice Address - Country:US
Practice Address - Phone:501-779-8327
Practice Address - Fax:501-500-5750
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered