Dr. Jerry Mayo, PHD, RDN
Dietitian, Registered, Nutrition, Obesity and Weight Management in Conway, AR. Individual provider (NPI-1).
NPI number1083239115
StatusActive
Last updated in NPPESJun 15, 2020
Details
- NPI
- 1083239115
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jerry Mayo
- Credential
- PHD, RDN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 15, 2020
- Certification date
- Jun 15, 2020
- Last updated
- Jun 15, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133VN1201X | Dietitian, Registered, Nutrition, Obesity and Weight Management | – | AR | Yes |
Practice location
1060 Applewood DrConway, AR 72034-3538
Phone 501-733-6575
Mailing address
1060 Applewood DrConway, AR 72034-3538
Phone 501-733-6575
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