Provider Demographics
NPI:1013691633
Name:HERNDON, KARA JO (RD)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:JO
Last Name:HERNDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4538
Mailing Address - Country:US
Mailing Address - Phone:509-330-1368
Mailing Address - Fax:
Practice Address - Street 1:1014 BURRELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5472
Practice Address - Country:US
Practice Address - Phone:208-748-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered