Provider Demographics
NPI:1093585879
Name:EASTERWOOD, AMY (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:EASTERWOOD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W PADDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8817
Mailing Address - Country:US
Mailing Address - Phone:417-343-4932
Mailing Address - Fax:
Practice Address - Street 1:5571 GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7287
Practice Address - Country:US
Practice Address - Phone:417-243-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered