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General NPI Number Information
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NPI Number | 1588302327
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Entity Type | Individual
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Provider Name | KINDANN MCMAHAN STONE FAWCETT PH.D., RD, LD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 305 E MAIN ST
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City | CABOT
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State | AR
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Zip | 72023-3034
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Country | US
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Telephone | 501-605-0310
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Fax | 501-605-0325
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Provider Business Mailing Address
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Address Line | 305 E MAIN ST
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City | CABOT
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State | AR
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Zip | 72023-3034
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Country | US
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Telephone | 501-605-0310
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Fax | 501-605-0325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 011976-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2919
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT87888
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2244
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License Number State | AR
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