Healthcare Provider Details

I. General information

NPI: 1235959990
Provider Name (Legal Business Name): KATI LIGON KEITH MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MERCY LN
SPRINGDALE AR
72762-3070
US

IV. Provider business mailing address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 501-672-6176
  • Fax:
Mailing address:
  • Phone: 479-338-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86415123
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: