Provider Demographics
NPI:1366059560
Name:DATHER, LORI JEAN (RDN, LD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:DATHER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COOK LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9436
Mailing Address - Country:US
Mailing Address - Phone:501-548-1534
Mailing Address - Fax:
Practice Address - Street 1:603 HARKRIDER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5633
Practice Address - Country:US
Practice Address - Phone:501-514-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR905133V00000X
AR0905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered