Provider Demographics
NPI:1801430871
Name:JONES, AMBER DANIELLE (RDN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DANIELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 HOPSON PIXLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9044
Mailing Address - Country:US
Mailing Address - Phone:662-645-1745
Mailing Address - Fax:
Practice Address - Street 1:1820 PEABODY ST
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9441
Practice Address - Country:US
Practice Address - Phone:662-363-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-03
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86067742133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86067742OtherCOMMISSION ON DIETETIC REGISTRATION