Basic Information
| Provider Information | |||||||||
| NPI: | 1770858037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THUL | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152842400 | ||||||||
| FaxNumber: | 6152844644 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 20TH AVE N STE 301 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152842400 | ||||||||
| FaxNumber: | 6152845871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2012 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 3068 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | Q00986A | 01 | TN | TN MEDICARE | OTHER | Q037404 | 05 | TN | MEDICAID |