Provider Demographics
NPI:1144245309
Name:MCHENRY, MARTHA L (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE B650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1166
Mailing Address - Country:US
Mailing Address - Phone:469-619-6921
Mailing Address - Fax:800-888-9560
Practice Address - Street 1:8330 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE B650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1166
Practice Address - Country:US
Practice Address - Phone:469-619-6921
Practice Address - Fax:800-888-9560
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144245309OtherNPI
TX8F2175Medicare ID - Type Unspecified