Provider Demographics
NPI:1699662817
Name:AMY QUALLS REGISTERED DIETITIAN NUTRITIONIST
Entity type:Organization
Organization Name:AMY QUALLS REGISTERED DIETITIAN NUTRITIONIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:870-834-2611
Mailing Address - Street 1:100 E PLEASURE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7710
Mailing Address - Country:US
Mailing Address - Phone:870-834-2611
Mailing Address - Fax:
Practice Address - Street 1:100 E PLEASURE AVE STE 4
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7710
Practice Address - Country:US
Practice Address - Phone:870-834-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty