Healthcare Provider Details

I. General information

NPI: 1316184583
Provider Name (Legal Business Name): LAURA B THROCKMORTON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 574
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

970 SCHERMAN OAKS CIR
CONWAY AR
72034-3499
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5788
  • Fax:
Mailing address:
  • Phone: 501-472-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number713
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: