Healthcare Provider Details

I. General information

NPI: 1386156628
Provider Name (Legal Business Name): PAMELA LANEY MS, RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S PINNACLE HILLS PKWY STE 300B
ROGERS AR
72758-9000
US

IV. Provider business mailing address

3333 S PINNACLE HILLS PKWY STE 300B
ROGERS AR
72758-9000
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-6085
  • Fax: 479-338-4607
Mailing address:
  • Phone: 479-338-6085
  • Fax: 479-338-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0156
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: