Provider Demographics
NPI:1427010123
Name:OLSON, JULIE A (RD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:JONES-DEPRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:502 RICHIE RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3309
Practice Address - Country:US
Practice Address - Phone:501-941-0940
Practice Address - Fax:501-941-1875
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05007133V00000X
AR1705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8971Medicare ID - Type Unspecified