Provider Demographics
NPI:1831334325
Name:MULLENS, TANYA LEANN REED (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LEANN REED
Last Name:MULLENS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:MULLENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:46 SPRINGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5430
Mailing Address - Country:US
Mailing Address - Phone:870-612-3576
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:574
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-6990
Practice Address - Fax:501-526-7977
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered