Provider Demographics
NPI:1619757499
Name:HENRY, MEGHAN LYNN (RDN)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LYNN
Last Name:HENRY
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 1:278 HIGHLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1656
Mailing Address - Country:US
Mailing Address - Phone:931-787-8003
Mailing Address - Fax:
Practice Address - Street 1:278 HIGHLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1656
Practice Address - Country:US
Practice Address - Phone:931-787-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11163133V00000X
TN3724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered