Healthcare Provider Details

I. General information

NPI: 1699687137
Provider Name (Legal Business Name): LINDSEY AMUNDSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 SW 11TH ST
MOORE OK
73160-2519
US

IV. Provider business mailing address

629 SW 11TH ST
MOORE OK
73160-2519
US

V. Phone/Fax

Practice location:
  • Phone: 405-249-0817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3223
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: