Provider Demographics
NPI:1285036962
Name:HUBBARD, AMANDA HENDERSON (RD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HENDERSON
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:5312 CREEKMONT TIMBERS TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-0835
Mailing Address - Country:US
Mailing Address - Phone:803-374-7023
Mailing Address - Fax:
Practice Address - Street 1:5312 CREEKMONT TIMBERS TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-0835
Practice Address - Country:US
Practice Address - Phone:803-374-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered