Healthcare Provider Details

I. General information

NPI: 1316714835
Provider Name (Legal Business Name): NICOLE MARIE BEYLA HAWKINS RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W MAPLE AVE STE 612
SPRINGDALE AR
72764-5335
US

IV. Provider business mailing address

3383 W VASSAR ST
FAYETTEVILLE AR
72704-6792
US

V. Phone/Fax

Practice location:
  • Phone: 479-757-4366
  • Fax:
Mailing address:
  • Phone: 479-340-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86278031
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: