Provider Demographics
NPI:1992367122
Name:PHILLIPS, CHERYL AMANDA (RDN)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:AMANDA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:AMANDA
Other - Last Name:CREGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:15401 CHENAL PKWY APT 4416
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2585
Mailing Address - Country:US
Mailing Address - Phone:479-445-2717
Mailing Address - Fax:
Practice Address - Street 1:521 JACK STEPHENS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5524
Practice Address - Country:US
Practice Address - Phone:501-686-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered