Healthcare Provider Details

I. General information

NPI: 1407795032
Provider Name (Legal Business Name): KATHLENE EDE HENDON RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 MASTERS PLACE WAY
DURHAM NC
27703-7654
US

IV. Provider business mailing address

1132 MASTERS PLACE WAY
DURHAM NC
27703-7654
US

V. Phone/Fax

Practice location:
  • Phone: 412-874-8773
  • Fax: 919-681-9575
Mailing address:
  • Phone: 412-874-8773
  • Fax: 919-681-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL009438
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: