Provider Demographics
NPI:1104461821
Name:BERNARD, HOLLY DANIELLE (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:DANIELLE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:DANIELLE
Other - Last Name:PLAMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:818 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4942
Mailing Address - Country:US
Mailing Address - Phone:479-441-5288
Mailing Address - Fax:
Practice Address - Street 1:818 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4942
Practice Address - Country:US
Practice Address - Phone:479-441-5288
Practice Address - Fax:479-441-4979
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered