Provider Demographics
NPI:1205696606
Name:KEARNS, AMY LYNN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:KEARNS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2127
Mailing Address - Country:US
Mailing Address - Phone:252-481-4028
Mailing Address - Fax:
Practice Address - Street 1:525 MAIN ST APT 5C
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2127
Practice Address - Country:US
Practice Address - Phone:252-481-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty