Provider Demographics
NPI:1912095431
Name:JOHNSON, PIPPA ALENE (RD, CDE)
Entity Type:Individual
Prefix:
First Name:PIPPA
Middle Name:ALENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10219 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2146
Mailing Address - Country:US
Mailing Address - Phone:501-954-8614
Mailing Address - Fax:
Practice Address - Street 1:4500 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-5815
Practice Address - Fax:501-257-5813
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered