Provider Demographics
NPI:1598171001
Name:DENNISON, AMY LYNN (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LYNN
Last Name:DENNISON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 HERR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4306
Mailing Address - Country:US
Mailing Address - Phone:502-550-2625
Mailing Address - Fax:
Practice Address - Street 1:1800 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1130
Practice Address - Country:US
Practice Address - Phone:502-361-2301
Practice Address - Fax:502-366-9779
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered