Provider Demographics
NPI:1477995603
Name:MARRIOTT, MELISSA (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SCENIC VALLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7066
Mailing Address - Country:US
Mailing Address - Phone:501-762-6418
Mailing Address - Fax:
Practice Address - Street 1:135 SCENIC VALLEY LOOP
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7066
Practice Address - Country:US
Practice Address - Phone:501-762-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1357133V00000X
GALD 003897133V00000X
AL2271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered