Healthcare Provider Details

I. General information

NPI: 1023794005
Provider Name (Legal Business Name): AMANDA ZEIGLER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WALKER RD.
PERKINSTON MS
39573
US

IV. Provider business mailing address

PO BOX 133
PERKINSTON MS
39573
US

V. Phone/Fax

Practice location:
  • Phone: 228-990-1427
  • Fax:
Mailing address:
  • Phone: 228-669-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86167910
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: