Provider Demographics
NPI:1407194483
Name:BOURNE, NATALIE NICOLE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:NICOLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2621 N EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3459
Mailing Address - Country:US
Mailing Address - Phone:501-352-6600
Mailing Address - Fax:
Practice Address - Street 1:813 FOUNDERS PARK DR E STE 107
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6321
Practice Address - Country:US
Practice Address - Phone:479-463-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered