Provider Demographics
NPI:1972320265
Name:STONE, MARY LANGLEY MONTEGUT (RD, MS)
Entity type:Individual
Prefix:
First Name:MARY LANGLEY
Middle Name:MONTEGUT
Last Name:STONE
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LANGLEY
Other - Last Name:MONTEGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8301 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-3911
Mailing Address - Country:US
Mailing Address - Phone:901-417-3312
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 556
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-7608
Practice Address - Fax:501-526-5148
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered