Provider Demographics
NPI:1942055694
Name:AMY GOODSON, LLC
Entity Type:Organization
Organization Name:AMY GOODSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSSD, LD
Authorized Official - Phone:214-298-3411
Mailing Address - Street 1:6769 REGELLO DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2386
Mailing Address - Country:US
Mailing Address - Phone:214-298-3411
Mailing Address - Fax:
Practice Address - Street 1:6769 REGELLO DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2386
Practice Address - Country:US
Practice Address - Phone:214-298-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty