Provider Demographics
NPI:1225420151
Name:HORNER, AMY D (MPH, RD, CLC, RDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:HORNER
Suffix:
Gender:F
Credentials:MPH, RD, CLC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 S LEWIS AND CLARK TRL
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-9547
Mailing Address - Country:US
Mailing Address - Phone:406-209-3995
Mailing Address - Fax:406-451-0551
Practice Address - Street 1:67 S LEWIS AND CLARK TRL
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-9547
Practice Address - Country:US
Practice Address - Phone:406-209-3995
Practice Address - Fax:406-451-0551
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT408133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered