Active NPI
Agnes Condren
- Registered Dietitian
- Little Rock, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1304
- Practice address
- 10020 N Rodney Parham Rd
Ste F
Little Rock, AR 72227-5588 - Phone
- (501) 779-8327
- NPI assigned
- Jan 19, 2016
- Last updated
- Sep 17, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1304 | AR | Primary |
Addresses
Primary practice location
10020 N Rodney Parham Rd
Ste F
Little Rock, AR 72227-5588
Mailing address
10020 N Rodney Parham Rd
Ste F
Little Rock, AR 72227-5588
Phone (501) 779-8327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160226000794 | AR | Practitioner - Registered Dietitian Or Nutrition Professional | 4183929219 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1304 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Condren Family Nutrition | Dietitian, Registered | Current | Accepting new patients |
| William H Freeman, MD PA | Current | Accepting new patients | |
| Courtney Byrum Rd LLC | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Locations
600 Club Ln
Conway, AR 72034
Phone (501) 327-0110
10020 N Rodney Parham Rd
Ste F
Little Rock, AR 72227
Phone (501) 779-8327
4 Shackleford Plz
Ste 209
Little Rock, AR 72211
Phone (501) 777-8120
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Conway, AR
- NPI 1982721882
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631836800000",
"number": "1265899421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10020 N RODNEY PARHAM RD",
"address_2": "STE F",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722275588",
"telephone_number": "501-779-8327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10020 N RODNEY PARHAM RD",
"address_2": "STE F",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722275588",
"telephone_number": "501-779-8327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONDREN",
"first_name": "AGNES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-19",
"last_updated": "2021-09-17",
"certification_date": "2021-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AR",
"license": "1304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.