Mary Jane Pettit, RD LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

807715 Issued in AR

Practice address

2200 Bruce St. Ste 101
Conway, AR 72034

Phone

(501) 470-7457

Fax

(501) 504-2105

NPI assigned

May 28, 2008

Last updated

Sep 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Central ArkansasGroup PAC ID 0042612244, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• University of Central Arkansas

  • Family Medicine Physician
  • Conway, AR
  • NPI 1912543240
  Medicare reassignment Care Compare group NPD
• University of Central Arkansas

  • Speech-Language Pathologist
  • Conway, AR
  • NPI 1184387540

  Dietitian, Registered

  NPD
• University of Central Arkansas

  • Physical Therapist
  • Conway, AR
  • NPI 1790439602

  Dietitian, Registered

  NPD
• St. Anthony's Hospital Association

  dba St. Vincent Morrilton

  • Critical Access Hospital
  • Morrilton, AR
  • NPI 1023160314
  NPD (past)
• St. Anthony's Hospital Association

  dba St. Vincent Morrilton

  • Critical Access Hospital
  • Morrilton, AR
  • NPI 1386796670
  NPD (past)

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1801054747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BRUCE ST. STE 101",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-470-7457",
            "fax_number": "501-504-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BRUCE ST. STE 101",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-470-7457",
            "fax_number": "501-504-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "RD LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AR",
            "license": "807715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101615105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan Lynn Person, PHARMD
• Kamrin Peters
• Mariah Anne Petersen, BCBA
• Riley Paige Petroff
• Samantha V Pettingill
• Ginah Brianne Pettyjohn, LPC
• Rebekah E Pevia, LCSW
• Brandon Dale Peyton
• Mattie Elaine Thi Pham
• Pharmacy Operations Inc (Medicine Shoppe)

• Registered Dietitian in Conway, AR
• Providers in Conway, AR by specialty
• Registered Dietitian in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.