MEDICARE: MS. AMY C MILLS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86418697	TX

General Provider Information

NPI Number	:	1598637316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY C MILLS RD

Provider Business Mailing Address
First Line	:	5227 EL CAMPO AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4841
Country	:	US
Telephone Number	:	817-296-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	5227 EL CAMPO AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4841
Country	:	US
Telephone Number	:	817-296-4615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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