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NPI Code Detail

MEDICARE: TERESA JOY AMOS RD LD LVN

MEDICARE: TERESA JOY AMOS RD LD LVN
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
1133V00000XRegistered DietitianDT07166TX

General Provider Information

NPI Number : 1821218330
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA JOY AMOS RD LD LVN
Provider Business Mailing Address
First Line : 5204 SHOAL CREEK BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78756-1813
Country : US
Telephone Number : 512-458-8576
Fax Number :
Provider Business Practice Location Address
First Line : 1717 W 10TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78703-3907
Country : US
Telephone Number : 512-472-3142
Fax Number : 512-472-4008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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Directions to “ TERESA JOY AMOS RD LD LVN” Practice Location

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