Provider Demographics
NPI:1619330230
Name:COLVIN, AMBER LEIGH (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEIGH
Last Name:COLVIN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:LEIGH
Other - Last Name:CASTLEBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0287
Mailing Address - Country:US
Mailing Address - Phone:907-543-6438
Mailing Address - Fax:907-543-6406
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0287
Practice Address - Country:US
Practice Address - Phone:907-543-6438
Practice Address - Fax:907-543-6406
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDTND335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered