Healthcare Provider Details

I. General information

NPI: 1679647937
Provider Name (Legal Business Name): MARION FIKE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BELL ST
AMARILLO TX
79109-6230
US

IV. Provider business mailing address

5800 BELL ST
AMARILLO TX
79109-6230
US

V. Phone/Fax

Practice location:
  • Phone: 806-677-5226
  • Fax: 806-677-5225
Mailing address:
  • Phone: 806-677-5226
  • Fax: 806-677-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06892
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: