Provider Demographics
NPI:1336486653
Name:PENDLEY, LYNN M (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:MATTINGLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:11820 DUANE POINT CIR
Mailing Address - Street 2:APT. 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1799
Mailing Address - Country:US
Mailing Address - Phone:502-424-9310
Mailing Address - Fax:
Practice Address - Street 1:9400 MILL BROOK RD
Practice Address - Street 2:NORTHEAST YMCA
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-425-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0797133V00000X
KY724766133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered