Provider Demographics
NPI:1265943856
Name:OFFIELD, AMANDA MARIE (MS, RD, LD, CNSC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:OFFIELD
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:DENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD, CNSC
Mailing Address - Street 1:6353 BATTLE MOUNTAIN TRAIL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:304-539-0243
Mailing Address - Fax:
Practice Address - Street 1:7800 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:682-291-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered