Provider Demographics
NPI:1558074302
Name:HENDERSON, JUDY LYNN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 COBLE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-6551
Mailing Address - Country:US
Mailing Address - Phone:615-712-0918
Mailing Address - Fax:
Practice Address - Street 1:3444 COBLE RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-6551
Practice Address - Country:US
Practice Address - Phone:615-712-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered