Healthcare Provider Details

I. General information

NPI: 1487939393
Provider Name (Legal Business Name): ELIZABETH BURNS CALLOWAY MS,RD,CSP,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
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

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-7541
  • Fax:
Mailing address:
  • Phone: 501-364-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1063
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: