MEDICARE: SARAH A STUART RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1190	AR
2	133VN1004X	Pediatric Nutrition Registered Dietitian	1190	AR

General Provider Information

NPI Number	:	1538432307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A STUART RD, LD

Provider Business Mailing Address
First Line	:	1704 HIDDEN VALLEY DR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-2112
Country	:	US
Telephone Number	:	870-219-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 MCCAIN PARK DR STE 116
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7813
Country	:	US
Telephone Number	:	870-219-2910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	08/07/2023

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