Provider Demographics
NPI:1609212380
Name:WEBB, AMY ANDREA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANDREA
Last Name:WEBB
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 1:1215 S COULTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1761
Mailing Address - Country:US
Mailing Address - Phone:806-677-7952
Mailing Address - Fax:
Practice Address - Street 1:1215 S COULTER ST STE 101
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1761
Practice Address - Country:US
Practice Address - Phone:806-677-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered