Healthcare Provider Details

I. General information

NPI: 1033172317
Provider Name (Legal Business Name): REBEKAH A CROWDER MS, RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

IV. Provider business mailing address

1201A OAK HILL DR
WHITE HALL AR
71602-8620
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-3274
  • Fax: 870-541-7933
Mailing address:
  • Phone: 870-541-3274
  • Fax: 870-541-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06459
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: