Provider Demographics
NPI:1205473980
Name:DEAN, AMY JEAN (RD LD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 W BEND
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7642
Mailing Address - Country:US
Mailing Address - Phone:409-338-5412
Mailing Address - Fax:
Practice Address - Street 1:990 IH 10 N STE 215
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1051
Practice Address - Country:US
Practice Address - Phone:409-338-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX806824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered