Provider Demographics
NPI:1700099397
Name:MCNALLY, LESLIE SUTTON (RD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUTTON
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSRDLD
Mailing Address - Street 1:12010 TIMBER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1725
Mailing Address - Country:US
Mailing Address - Phone:501-529-0508
Mailing Address - Fax:
Practice Address - Street 1:12010 TIMBER CREEK RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-1725
Practice Address - Country:US
Practice Address - Phone:501-529-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR000991082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR000991082OtherLICENSE