Provider Demographics
NPI:1932554979
Name:MOREHEAD, TORI LYNN
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:LYNN
Last Name:MOREHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TORI
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:3050 TWIN RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4218
Mailing Address - Country:US
Mailing Address - Phone:501-526-4892
Mailing Address - Fax:501-296-1308
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-4892
Practice Address - Fax:501-296-1308
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2019-10-07
Deactivation Date:2019-09-12
Deactivation Code:
Reactivation Date:2019-09-30
Provider Licenses
StateLicense IDTaxonomies
AR1426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered