Healthcare Provider Details

I. General information

NPI: 1649625914
Provider Name (Legal Business Name): DANS-DIABETES AND NUTRITION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SEZANNE DR
LITTLE ROCK AR
72223-5094
US

IV. Provider business mailing address

204 SEZANNE DR
LITTLE ROCK AR
72223-5094
US

V. Phone/Fax

Practice location:
  • Phone: 501-830-3115
  • Fax:
Mailing address:
  • Phone: 501-830-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02066
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER I HALL
Title or Position: FOUNDER, OWNER AND CEO
Credential: MS, RDN, LDN, CDCES
Phone: 501-703-0882