Provider Demographics
NPI:1821359050
Name:KINNEY, AMANDA LYNN (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:KINNEY
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 1:8825 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1108
Mailing Address - Country:US
Mailing Address - Phone:904-399-4004
Mailing Address - Fax:904-399-3489
Practice Address - Street 1:8825 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1108
Practice Address - Country:US
Practice Address - Phone:904-399-4004
Practice Address - Fax:904-399-3489
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered