Active NPI
Amy M. Gannon, RDLD
- Registered Dietitian
- Huntington, WV
National Provider Identifier
1962743773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 438
- Practice address
- 1 John Marshall Dr
Huntington, WV 25755-0003 - Phone
- (304) 696-4336
- NPI assigned
- Mar 5, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 438 | WV | Primary |
Addresses
Primary practice location
1 John Marshall Dr
Huntington, WV 25755-0003
Mailing address
1 John Marshall Dr
Huntington, WV 25755-0003
Phone (304) 696-4336
Other names 1
- Amy M. Graham
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 438 | WV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1962743773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 JOHN MARSHALL DR",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257550003",
"telephone_number": "304-696-4336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 JOHN MARSHALL DR",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257550003",
"telephone_number": "304-696-4336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "AMY",
"middle_name": "M.",
"credential": "RDLD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-05",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WV",
"license": "438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMY",
"last_name": "GRAHAM",
"middle_name": "M.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Huntington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.