Provider Demographics
NPI:1811409915
Name:CUMMINS, AMY KATHERINE (RDN, CD, LD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:RDN, CD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 LAKE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-5946
Mailing Address - Country:US
Mailing Address - Phone:812-455-4781
Mailing Address - Fax:
Practice Address - Street 1:3010 LAKE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-5946
Practice Address - Country:US
Practice Address - Phone:812-455-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001823A133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic