Healthcare Provider Details

I. General information

NPI: 1396483582
Provider Name (Legal Business Name): MISTI STRASNER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 POLK ROAD 96
MENA AR
71953-8590
US

IV. Provider business mailing address

131 POLK ROAD 96
MENA AR
71953-8590
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-0008
  • Fax:
Mailing address:
  • Phone: 501-622-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0806
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number915331
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: