# DIABETES & KIDNEY DISEASE PREVENTION PROGRAM, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669386876
- **Authorized official:** NICOLE DANISE BATES FNP-BC (EXECUTIVE DIRECTOR, LIFESTYLE COACH)
- **Authorized official phone:** (870) 718-6329

## Contact information

- **Practice address:** 1007 FAIRWAY DR, PINE BLUFF, AR 71603-8105
- **Practice address phone:** (870) 718-6329
- **Mailing address:** 1007 FAIRWAY DR, PINE BLUFF, AR 71603-8105
- **Mailing address phone:** (870) 718-6329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2026
- **Last updated:** 10/02/2026