Provider Demographics
NPI:1558007476
Name:NUTRITIONALLY AOK
Entity Type:Organization
Organization Name:NUTRITIONALLY AOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTICE DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:OCHSENBEIN
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CLC
Authorized Official - Phone:423-227-5017
Mailing Address - Street 1:6103 HUNTER CREST DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6508
Mailing Address - Country:US
Mailing Address - Phone:423-227-5017
Mailing Address - Fax:
Practice Address - Street 1:6103 HUNTER CREST DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6508
Practice Address - Country:US
Practice Address - Phone:423-227-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2167OtherTENNESSEE DEPARTMENT OF HEALTH