1336273028 NPI number — JANELLE LINDSEY WILLIAMSON RD, LD, CDE

Table of content: JANELLE LINDSEY WILLIAMSON RD, LD, CDE (NPI 1336273028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336273028 NPI number — JANELLE LINDSEY WILLIAMSON RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
JANELLE
Provider Middle Name:
LINDSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336273028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2302 COLLEGE AVE
Provider Second Line Business Mailing Address:
DIABETES CENTER
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-6297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-932-3236
Provider Business Mailing Address Fax Number:
501-513-5229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2302 COLLEGE AVE
Provider Second Line Business Practice Location Address:
DIABETES CENTER
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-6297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-932-3236
Provider Business Practice Location Address Fax Number:
501-513-5229
Provider Enumeration Date:
03/15/2007

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:  2006030907 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 1245 , 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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