Provider Demographics
NPI:1013954577
Name:MEADOR, AMY LYNN (RDLD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:MEADOR
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1429
Mailing Address - Country:US
Mailing Address - Phone:270-237-4423
Mailing Address - Fax:
Practice Address - Street 1:107 N COURT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1429
Practice Address - Country:US
Practice Address - Phone:270-237-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0277909Medicare PIN
KY0277309Medicare PIN
KY0277511Medicare PIN
KY0049048Medicare PIN
KY0277409Medicare PIN
KY0277709Medicare PIN
KY0277609Medicare PIN