MEDICARE: AMY D HORNER MPH, RD, CLC, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	408	MT

General Provider Information

NPI Number	:	1225420151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY D HORNER MPH, RD, CLC, RDN

Provider Business Mailing Address
First Line	:	67 S LEWIS AND CLARK TRL
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-9547
Country	:	US
Telephone Number	:	406-209-3995
Fax Number	:	406-451-0551

Provider Business Practice Location Address
First Line	:	67 S LEWIS AND CLARK TRL
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-9547
Country	:	US
Telephone Number	:	406-209-3995
Fax Number	:	406-451-0551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	07/25/2024

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