Healthcare Provider Details

I. General information

NPI: 1982438669
Provider Name (Legal Business Name): KRISTEN MCCLENDON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 HIGHWAY 321 E
AUSTIN AR
72007-9047
US

IV. Provider business mailing address

2820 HIGHWAY 321 E
AUSTIN AR
72007-9047
US

V. Phone/Fax

Practice location:
  • Phone: 479-799-1630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1453
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1076058
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: