Provider Demographics
NPI:1578054516
Name:BOYER, AMANDA KAY (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:BOYER
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 S STRAIN RIDGE ROAD
Mailing Address - Street 2:PO BOX #140
Mailing Address - City:SMITHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47458-9998
Mailing Address - Country:US
Mailing Address - Phone:765-541-2165
Mailing Address - Fax:
Practice Address - Street 1:1136 W 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3000
Practice Address - Country:US
Practice Address - Phone:765-541-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86026809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered