Provider Demographics
NPI:1235398819
Name:WATSON, AMY (RD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WATSON
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 1:812 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2019
Mailing Address - Country:US
Mailing Address - Phone:317-445-1538
Mailing Address - Fax:765-779-4010
Practice Address - Street 1:812 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2019
Practice Address - Country:US
Practice Address - Phone:317-445-1538
Practice Address - Fax:765-779-4010
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001376A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37001376AOtherINDIANA CERTIFICATION