Provider Demographics
NPI:1275774564
Name:DAVIS, JEANE ELIZABETH (RD,LD)
Entity type:Individual
Prefix:
First Name:JEANE
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 CANTRELL RD
Mailing Address - Street 2:APT 1606
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2451
Mailing Address - Country:US
Mailing Address - Phone:479-409-1303
Mailing Address - Fax:
Practice Address - Street 1:8101 CANTRELL RD
Practice Address - Street 2:APT 1606
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2451
Practice Address - Country:US
Practice Address - Phone:479-409-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR989656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered