Healthcare Provider Details

I. General information

NPI: 1548956873
Provider Name (Legal Business Name): AMY C JOHNSON MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NRG STADIUM TWO NRG PARK
HOUSTON TX
77054
US

IV. Provider business mailing address

1744 1/2 W MAIN ST
HOUSTON TX
77098-3608
US

V. Phone/Fax

Practice location:
  • Phone: 832-544-1359
  • Fax:
Mailing address:
  • Phone: 337-396-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86094557
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: