Healthcare Provider Details

I. General information

NPI: 1538432307
Provider Name (Legal Business Name): SARAH A STUART RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 MCCAIN PARK DR STE 116
NORTH LITTLE ROCK AR
72116-7813
US

IV. Provider business mailing address

1704 HIDDEN VALLEY DR
BENTON AR
72019-2112
US

V. Phone/Fax

Practice location:
  • Phone: 870-219-2910
  • Fax:
Mailing address:
  • Phone: 870-219-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1190
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1190
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: