Provider Demographics
NPI:1417979832
Name:MONK, MICAH LEA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:LEA
Last Name:MONK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:MICAH
Other - Middle Name:LEA
Other - Last Name:WING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2036 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2018
Mailing Address - Country:US
Mailing Address - Phone:806-206-4772
Mailing Address - Fax:806-354-1679
Practice Address - Street 1:NORTHWEST TEXAS HEALTHCARE SYSTEM
Practice Address - Street 2:1501 SOUTH COULTER
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-354-1720
Practice Address - Fax:806-354-1679
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX923397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered