Provider Demographics
NPI:1669853438
Name:SELLERS, CRISTY (RD)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W 10TH ST
Mailing Address - Street 2:SUTIE 810
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1752
Mailing Address - Country:US
Mailing Address - Phone:501-661-2508
Mailing Address - Fax:501-661-2271
Practice Address - Street 1:5800 W 10TH ST
Practice Address - Street 2:SUTIE 810
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1752
Practice Address - Country:US
Practice Address - Phone:501-661-2508
Practice Address - Fax:501-661-2271
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered