Provider Demographics
NPI:1023794005
Name:ZEIGLER, AMANDA (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZEIGLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:PERKINSTON
Mailing Address - State:MS
Mailing Address - Zip Code:39573
Mailing Address - Country:US
Mailing Address - Phone:228-669-1427
Mailing Address - Fax:
Practice Address - Street 1:88 WALKER RD.
Practice Address - Street 2:
Practice Address - City:PERKINSTON
Practice Address - State:MS
Practice Address - Zip Code:39573
Practice Address - Country:US
Practice Address - Phone:228-990-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS86167910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered