Healthcare Provider Details

I. General information

NPI: 1104278043
Provider Name (Legal Business Name): AMANDA KAYE ARNOLD MSPAS, RDN, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KAYE WATTS

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S KANNER HWY
STUART FL
34994-4801
US

IV. Provider business mailing address

200 SE HOSPITAL AVE # 2346
STUART FL
34994-2346
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-2003
  • Fax: 772-288-5835
Mailing address:
  • Phone: 216-490-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119077
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: