Healthcare Provider Details

I. General information

NPI: 1043876386
Provider Name (Legal Business Name): AMANDA ELLEN HELTON RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

50 N DUNLAP ST
MEMPHIS TN
38103-2800
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6140
  • Fax: 901-287-5123
Mailing address:
  • Phone: 901-287-6140
  • Fax: 901-287-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1489
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: