Provider Demographics
NPI:1669344453
Name:MUNCRIEF, AMY (MSRDLD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MUNCRIEF
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 SLATECREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72087-9710
Mailing Address - Country:US
Mailing Address - Phone:501-317-1864
Mailing Address - Fax:
Practice Address - Street 1:1038 SLATECREEK WAY
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087-9710
Practice Address - Country:US
Practice Address - Phone:501-317-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty