Healthcare Provider Details

I. General information

NPI: 1659293637
Provider Name (Legal Business Name): KRISTEN ANN CREIGHTON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 E MATTHEWS AVE
JONESBORO AR
72401-4362
US

IV. Provider business mailing address

3945 NEW POND HILL DR
JONESBORO AR
72405-8024
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-0531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2455
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: