Active NPI
Amy Puckett, RD
- Registered Dietitian
- Peoria, AZ
National Provider Identifier
1962829317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86009206
- Practice address
- 13090 N 94TH Dr Ste 210
Peoria, AZ 85381 - Phone
- (623) 974-1763
- Fax
- (623) 972-2038
- NPI assigned
- Mar 24, 2014
- 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 | 86009206 | AZ | Primary |
Addresses
Primary practice location
13090 N 94TH Dr Ste 210
Peoria, AZ 85381
Mailing address
25614 N 92ND Ave
Peoria, AZ 85383-1274
Phone (480) 717-2100
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 |
|---|---|---|---|
| 86009206 | AZ | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1962829317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25614 N 92ND AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853831274",
"telephone_number": "480-717-2100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13090 N 94TH DR STE 210",
"city": "PEORIA",
"state": "AZ",
"postal_code": "85381",
"telephone_number": "623-974-1763",
"fax_number": "623-972-2038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "AMY",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-24",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "86009206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.