Provider Demographics
NPI:1508562950
Name:BAKIOS, AMY (RD, CD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAKIOS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 CHELEMES WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6222
Mailing Address - Country:US
Mailing Address - Phone:520-307-5124
Mailing Address - Fax:
Practice Address - Street 1:1924 CHELEMES WAY
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6222
Practice Address - Country:US
Practice Address - Phone:520-307-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered