Healthcare Provider Details

I. General information

NPI: 1477354165
Provider Name (Legal Business Name): ADRIA BUEG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIA KILGORE

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAPLEWOOD RD
HARRISON AR
72601-3005
US

IV. Provider business mailing address

5851 WHITE OAK RD
HARRISON AR
72601-5863
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-5001
  • Fax:
Mailing address:
  • Phone: 870-688-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number1488
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: