Provider Demographics
NPI:1811588262
Name:UMPHREY, JOY LYNN (RDN)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:LYNN
Last Name:UMPHREY
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 1:11002 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-3927
Mailing Address - Country:US
Mailing Address - Phone:602-696-8244
Mailing Address - Fax:602-396-5848
Practice Address - Street 1:11002 E GROVE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-3927
Practice Address - Country:US
Practice Address - Phone:602-696-8244
Practice Address - Fax:602-396-5848
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86100035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered