Provider Demographics
NPI:1689854127
Name:SANDERS, AMY H (RD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:H
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4540
Mailing Address - Country:US
Mailing Address - Phone:270-443-0885
Mailing Address - Fax:270-443-9068
Practice Address - Street 1:632 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4540
Practice Address - Country:US
Practice Address - Phone:270-443-0885
Practice Address - Fax:270-443-9068
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered