Provider Demographics
NPI:1750081147
Name:CUMMINGS, HOLLY ELAINE (RD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELAINE
Last Name:CUMMINGS
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 1:6 E POST OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3415
Mailing Address - Country:US
Mailing Address - Phone:501-697-2821
Mailing Address - Fax:
Practice Address - Street 1:6 E POST OAK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3415
Practice Address - Country:US
Practice Address - Phone:501-697-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered