Provider Demographics
NPI:1639409865
Name:AST, AMANDA KAY (RD, CDE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:AST
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7410 GOLDEN POND PLACE SUITE 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121
Mailing Address - Country:US
Mailing Address - Phone:806-316-5595
Mailing Address - Fax:
Practice Address - Street 1:7410 GOLDEN POND PLACE SUITE 400
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121
Practice Address - Country:US
Practice Address - Phone:806-316-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered