Provider Demographics
NPI:1679990246
Name:CAMENISCH, AMY LORRAINE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LORRAINE
Last Name:CAMENISCH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 WILHITE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3385
Mailing Address - Country:US
Mailing Address - Phone:859-278-6031
Mailing Address - Fax:
Practice Address - Street 1:2620 WILHITE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3385
Practice Address - Country:US
Practice Address - Phone:859-278-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered