Healthcare Provider Details

I. General information

NPI: 1114640752
Provider Name (Legal Business Name): ALLISON GREY BAILEY MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON GREY NAGEL MS, RDN

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

IV. Provider business mailing address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-7998
  • Fax:
Mailing address:
  • Phone: 501-219-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1010
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: