Diabetes & Kidney Disease Prevention Program, LLC

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Legal business name

DIABETES & KIDNEY DISEASE PREVENTION PROGRAM, LLC

Practice address

1007 Fairway Dr
Pine Bluff, AR 71603-8105

Phone

(870) 718-6329

NPI assigned

Oct 2, 2026

Last updated

Oct 2, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Danise Bates, FNP-BC

Title

Executive Director, Lifestyle Coach

Phone

(870) 718-6329

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1669386876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 FAIRWAY DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716038105",
            "telephone_number": "870-718-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 FAIRWAY DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716038105",
            "telephone_number": "870-718-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES & KIDNEY DISEASE PREVENTION PROGRAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-02",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "DANISE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, LIFESTYLE COACH",
        "authorized_official_telephone_number": "870-718-6329",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diet of a Lifetime, LLC

• Health & Wellness Coach in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Health & Wellness Coach in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.