Individual
MRS. MARY JANE PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
2200 BRUCE ST. STE 101, CONWAY, AR 72034
(501) 470-7457
(501) 504-2105
Mailing address
2200 BRUCE ST. STE 101, CONWAY, AR 72034
(501) 470-7457
(501) 504-2105
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
807715
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101615105
—
AR
Enumeration date
05/28/2008
Last updated
09/13/2022
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