Provider Demographics
NPI:1528847076
Name:REDDING, MIRANDA (RD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:REDDING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23378 W HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-9065
Mailing Address - Country:US
Mailing Address - Phone:501-213-7265
Mailing Address - Fax:
Practice Address - Street 1:23378 W HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-9065
Practice Address - Country:US
Practice Address - Phone:501-213-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered