Active NPI
Ama Gean Wallace, RD
- Registered Dietitian
- North Little Rock, AR
National Provider Identifier
1982796405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 0257
- Practice address
- 2200 Fort Roots Dr
North Little Rock, AR 72114-1709 - Phone
- (501) 257-2017
- Fax
- (501) 257-2026
- NPI assigned
- Sep 29, 2006
- Last updated
- Jul 8, 2007
- 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 | 0257 | AR | Primary |
Addresses
Primary practice location
2200 Fort Roots Dr
North Little Rock, AR 72114-1709
Mailing address
22 Latour
Little Rock, AR 72223-8904
Phone (501) 257-2017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R660145 | Other | AR | REGISTRATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0257 | AR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982796405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 LATOUR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722238904",
"telephone_number": "501-257-2017",
"fax_number": "501-257-2026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-2017",
"fax_number": "501-257-2026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "AMA",
"middle_name": "GEAN",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AR",
"license": "0257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "R660145",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.