Provider Demographics
NPI:1104281294
Name:ROMERO, MOLLY ANN (MS RDN, LDN, CSOWM)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MS RDN, LDN, CSOWM
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:BOWDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LDN, RDN, CDCES
Mailing Address - Street 1:9300 WHITE OAK CROSSING
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6377
Mailing Address - Country:US
Mailing Address - Phone:501-777-8120
Mailing Address - Fax:501-229-6070
Practice Address - Street 1:9300 WHITE OAK CROSSING
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6377
Practice Address - Country:US
Practice Address - Phone:501-777-8120
Practice Address - Fax:501-229-6070
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1087167133V00000X
FL7930133V00000X
133VN1201X
AR1917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1917OtherARKANSAS DIETETIC LICENSING BOARD
32300613OtherCERTIFIED DIABETES CARE AND EDUCATION SPECIALIST