Healthcare Provider Details

I. General information

NPI: 1366837197
Provider Name (Legal Business Name): SARAH KATHERINE RHODES RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

5400 CHENONCEAU BLVD APT 937
LITTLE ROCK AR
72223-4755
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2638
  • Fax:
Mailing address:
  • Phone: 479-466-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1017475
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1017475
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1017475
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: