Provider Demographics
NPI:1649829128
Name:HENDRICK, BROOKE CARROLL (RD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CARROLL
Last Name:HENDRICK
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 1:4506 EPINAY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2777
Mailing Address - Country:US
Mailing Address - Phone:502-619-2458
Mailing Address - Fax:
Practice Address - Street 1:4506 EPINAY CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2777
Practice Address - Country:US
Practice Address - Phone:502-619-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86090047133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered