Healthcare Provider Details

I. General information

NPI: 1821883778
Provider Name (Legal Business Name): KAYLEE GOINGS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 SPRINGDALE AVE
SPRINGDALE AR
72762-4346
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 479-756-1699
  • Fax: 479-756-1693
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86130402
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: