Provider Demographics
NPI:1912140237
Name:ANDERSON, AMY LYNN (MS, RD, LD/N)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24042 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1500
Mailing Address - Country:US
Mailing Address - Phone:832-552-3966
Mailing Address - Fax:
Practice Address - Street 1:24042 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1500
Practice Address - Country:US
Practice Address - Phone:832-552-3966
Practice Address - Fax:888-785-6973
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81743133V00000X
MDD02036133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist