Healthcare Provider Details

I. General information

NPI: 1912140237
Provider Name (Legal Business Name): AMY LYNN ANDERSON M.S., R.D., L.D./N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 OLD FROSTBURG RD
FROSTBURG MD
21532-4239
US

IV. Provider business mailing address

24042 HIGHWAY 59 N
KINGWOOD TX
77339-1500
US

V. Phone/Fax

Practice location:
  • Phone: 832-552-3966
  • Fax:
Mailing address:
  • Phone: 832-552-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberD02036
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: