Healthcare Provider Details

I. General information

NPI: 1720365752
Provider Name (Legal Business Name): ARKANSAS CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
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: 501-364-2601
  • Fax: 501-364-6918
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1022
License Number StateAR

VIII. Authorized Official

Name: MRS. MEGAN DUNN-MCDERMOTT GREEN
Title or Position: CLINICAL DIETITIAN II
Credential: MS, RD, CSP, LD
Phone: 501-364-2601