Provider Demographics
NPI:1023898327
Name:WHITENER, MARLEY MITCHELL (RD)
Entity type:Individual
Prefix:
First Name:MARLEY
Middle Name:MITCHELL
Last Name:WHITENER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARLEY
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7806
Mailing Address - Country:US
Mailing Address - Phone:423-823-8491
Mailing Address - Fax:
Practice Address - Street 1:201 LOGAN DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7806
Practice Address - Country:US
Practice Address - Phone:423-823-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered