MEDICARE: DONNA STIMSON MS, 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	1237	AR

General Provider Information

NPI Number	:	1700489143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA STIMSON MS, RD, LD

Provider Business Mailing Address
First Line	:	6929 J.F.K. BLVD.
Second Line	:	STE. 20- 242
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5331
Country	:	US
Telephone Number	:	501-247-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	6929 J.F.K. BLVD.
Second Line	:	STE. 20- 242
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5331
Country	:	US
Telephone Number	:	501-247-8818
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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