Provider Demographics
NPI:1982194684
Name:PLANT-POWERED KIDNEYS INC.
Entity Type:Organization
Organization Name:PLANT-POWERED KIDNEYS INC.
Other - Org Name:JEN HERNANDEZ RD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CSR, LDN
Authorized Official - Phone:520-240-7552
Mailing Address - Street 1:9900 SPECTRUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4555
Mailing Address - Country:US
Mailing Address - Phone:575-808-8844
Mailing Address - Fax:
Practice Address - Street 1:422 CABERNET DRIVE
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-8407
Practice Address - Country:US
Practice Address - Phone:575-209-4700
Practice Address - Fax:575-404-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1082987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082987OtherREGISTERED DIETITIAN