1831334325 NPI number — TANYA LEANN REED MULLENS MS, RD, LD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831334325 NPI number — TANYA LEANN REED MULLENS MS, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLENS
Provider First Name:
TANYA
Provider Middle Name:
LEANN REED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLENS
Provider Other First Name:
LEANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831334325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 SPRINGRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-612-3576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 W MARKHAM ST
Provider Second Line Business Practice Location Address:
574
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-526-6990
Provider Business Practice Location Address Fax Number:
501-526-7977
Provider Enumeration Date:
12/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  984 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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