Healthcare Provider Details

I. General information

NPI: 1053868240
Provider Name (Legal Business Name): COURTNEY E SUTTERFIELD RD/RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ENCORE WAY
BRYANT AR
72019-8896
US

IV. Provider business mailing address

7909 S SHORELINE BLVD
BENTON AR
72019-8795
US

V. Phone/Fax

Practice location:
  • Phone: 501-213-4500
  • Fax: 501-686-8586
Mailing address:
  • Phone: 501-590-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1359
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: