Provider Demographics
NPI:1700489143
Name:STIMSON, DONNA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STIMSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 J.F.K. BLVD.
Mailing Address - Street 2:STE. 20- 242
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5331
Mailing Address - Country:US
Mailing Address - Phone:501-247-8818
Mailing Address - Fax:
Practice Address - Street 1:6929 J.F.K. BLVD.
Practice Address - Street 2:STE. 20- 242
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-5331
Practice Address - Country:US
Practice Address - Phone:501-247-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered