Individual
CARLY ELIZABETH GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, IBCLC
Contact information
Practice address
6035 W TRANSIT ST, FAYETTEVILLE, AR 72704-5097
(479) 485-1215
Mailing address
3069 N NIGHT HERON DR, FAYETTEVILLE, AR 72704-5007
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1140
AR
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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