Provider Demographics
NPI:1902235302
Name:FAULKNER, JAMI LYNN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:LYNN
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LEDRICK CIR
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-8404
Mailing Address - Country:US
Mailing Address - Phone:479-461-2222
Mailing Address - Fax:
Practice Address - Street 1:6 LEDRICK CIR
Practice Address - Street 2:
Practice Address - City:MAYFLOWER
Practice Address - State:AR
Practice Address - Zip Code:72106-8404
Practice Address - Country:US
Practice Address - Phone:479-461-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered