MEDICARE: CASEY SAMS RD

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	0543	AR

General Provider Information

NPI Number	:	1952711848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY SAMS RD

Provider Business Mailing Address
First Line	:	10773 COOSE HOLLOW LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-8968
Country	:	US
Telephone Number	:	479-366-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	10773 COOSE HOLLOW LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-8968
Country	:	US
Telephone Number	:	479-366-1755
Fax Number	:

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

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	01/08/2026

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Directions to “ CASEY SAMS RD” Practice Location

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