Provider Demographics
NPI:1558714063
Name:HERINGER, AMANDA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HERINGER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 E MATTHEWS AVE
Mailing Address - Street 2:ST. BERNARDS HEALTH AND WELLNESS
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4362
Mailing Address - Country:US
Mailing Address - Phone:870-207-7823
Mailing Address - Fax:870-207-0525
Practice Address - Street 1:1416 E MATTHEWS AVE
Practice Address - Street 2:ST. BERNARDS HEALTH AND WELLNESS
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4362
Practice Address - Country:US
Practice Address - Phone:870-207-7823
Practice Address - Fax:870-207-0525
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered