Provider Demographics
NPI:1336273028
Name:WILLIAMSON, JANELLE LINDSEY (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:LINDSEY
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 COLLEGE AVE
Mailing Address - Street 2:DIABETES CENTER
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6297
Mailing Address - Country:US
Mailing Address - Phone:501-932-3236
Mailing Address - Fax:501-513-5229
Practice Address - Street 1:2302 COLLEGE AVE
Practice Address - Street 2:DIABETES CENTER
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6297
Practice Address - Country:US
Practice Address - Phone:501-932-3236
Practice Address - Fax:501-513-5229
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030907133V00000X
AR1245133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered