Provider Demographics
NPI:1538425335
Name:HODNETT, CYNTHIA ELLEN (RD, CDE)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:HODNETT
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 SHEPARD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1921
Mailing Address - Country:US
Mailing Address - Phone:501-868-7858
Mailing Address - Fax:
Practice Address - Street 1:6015 CHENONCEAU BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4583
Practice Address - Country:US
Practice Address - Phone:501-868-1200
Practice Address - Fax:501-868-1399
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered