Provider Demographics
NPI:1780943316
Name:SARTAIN, LYDIA PAULINE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:PAULINE
Last Name:SARTAIN
Suffix:
Gender:F
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 1:710 CENTER RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:DRASCO
Mailing Address - State:AR
Mailing Address - Zip Code:72530-3416
Mailing Address - Country:US
Mailing Address - Phone:870-213-6432
Mailing Address - Fax:
Practice Address - Street 1:9601 INTERSTATE 630 EXIT 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7202
Practice Address - Country:US
Practice Address - Phone:870-213-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered