Provider Demographics
NPI:1952593113
Name:DUNN, BRENDA TALLEY (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:TALLEY
Last Name:DUNN
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 1:100 SE LINE RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-9268
Mailing Address - Country:US
Mailing Address - Phone:501-412-4282
Mailing Address - Fax:870-262-1365
Practice Address - Street 1:1710 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7303
Practice Address - Country:US
Practice Address - Phone:870-262-1291
Practice Address - Fax:870-262-1365
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered