Healthcare Provider Details

I. General information

NPI: 1760205108
Provider Name (Legal Business Name): ALYSSA KATELYN ARNOLD MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 AWIXA ST NW
WALKER MI
49534-7716
US

IV. Provider business mailing address

1968 AWIXA ST NW
WALKER MI
49534-7716
US

V. Phone/Fax

Practice location:
  • Phone: 616-821-2337
  • Fax:
Mailing address:
  • Phone: 616-821-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: