Healthcare Provider Details

I. General information

NPI: 1003028820
Provider Name (Legal Business Name): TAMMY NEZ YOUNG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WAGON WHEEL RD
SPRINGDALE AR
72762-0137
US

IV. Provider business mailing address

6311 WELLS CIR
SPRINGDALE AR
72762-6047
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-3043
  • Fax: 479-725-3098
Mailing address:
  • Phone: 479-725-3043
  • Fax: 479-725-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number266
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: