Provider Demographics
NPI:1295993897
Name:BROWN, AMY MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:866-273-5392
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:2125 STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4987
Practice Address - Country:US
Practice Address - Phone:881-294-9551
Practice Address - Fax:812-949-7191
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001102A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered