Provider Demographics
NPI:1437603727
Name:WEEKS, CONNELLY (RDN, LD)
Entity type:Individual
Prefix:MISS
First Name:CONNELLY
Middle Name:
Last Name:WEEKS
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 1:3922 S LOOKOUT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2028
Mailing Address - Country:US
Mailing Address - Phone:501-773-7315
Mailing Address - Fax:
Practice Address - Street 1:3922 S LOOKOUT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2028
Practice Address - Country:US
Practice Address - Phone:501-773-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered