Provider Demographics
NPI:1598429235
Name:HENDERSON, KASSANDRA MARIE (RDN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SE 2ND ST APT 2108
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-3029
Mailing Address - Country:US
Mailing Address - Phone:812-430-9903
Mailing Address - Fax:
Practice Address - Street 1:1320 SE 2ND ST APT 2108
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-3029
Practice Address - Country:US
Practice Address - Phone:812-430-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003274A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered