Provider Demographics
NPI:1730674094
Name:RYAN, AMY JEAN (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:RYAN
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 1:2102 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1946
Mailing Address - Country:US
Mailing Address - Phone:615-613-6160
Mailing Address - Fax:
Practice Address - Street 1:300 PAGEANT LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3854
Practice Address - Country:US
Practice Address - Phone:931-648-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered