Healthcare Provider Details

I. General information

NPI: 1750240339
Provider Name (Legal Business Name): DANIEL RENARD ANDERSON JR. BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 MCCLANAHAN DR STE E2
NORTH LITTLE ROCK AR
72116-7076
US

IV. Provider business mailing address

6108 MCPHERSON RD
LITTLE ROCK AR
72204-8827
US

V. Phone/Fax

Practice location:
  • Phone: 903-556-9594
  • Fax:
Mailing address:
  • Phone: 903-556-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: