Provider Demographics
NPI:1407937535
Name:LEONARD, AMANDA SARAH (RD, LD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SARAH
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N ROSS ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-2240
Mailing Address - Country:US
Mailing Address - Phone:918-373-7002
Mailing Address - Fax:
Practice Address - Street 1:612 N ROSS ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-2240
Practice Address - Country:US
Practice Address - Phone:918-373-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK891989133V00000X
OK1473332B00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
8ED429Medicare PIN
8ED427Medicare PIN
8ED430Medicare PIN
OK8ED436Medicare PIN
OK8ED428Medicare PIN
8ED434Medicare PIN
8ED435Medicare PIN
8ED432Medicare PIN
8ED433Medicare PIN
OK8ED431Medicare PIN