Healthcare Provider Details

I. General information

NPI: 1760570220
Provider Name (Legal Business Name): MELINDA J SAXTON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH STREET LR/120 CAVHS,
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

408 COUNTRY CLUB RD
CONWAY AR
72034-7212
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6200
  • Fax:
Mailing address:
  • Phone: 501-336-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number576
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: