Healthcare Provider Details

I. General information

NPI: 1104281294
Provider Name (Legal Business Name): MOLLY ANN ROMERO MS. RDN, LDN, CSOWM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY ANN BOWDON MS, LDN, RDN, CDCES

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 10/11/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 WHITE OAK CROSSING
NORTH LITTLE ROCK AR
72113-6377
US

IV. Provider business mailing address

9300 WHITE OAK CROSSING
MAUMELLE AR
72113-6377
US

V. Phone/Fax

Practice location:
  • Phone: 501-777-8120
  • Fax: 501-229-6070
Mailing address:
  • Phone: 501-777-8120
  • Fax: 501-229-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1087167
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7930
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1917
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: