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NPI Code Detail

MEDICARE: MARTHA L MCHENRY RD, LD, CDE

MEDICARE: MARTHA L MCHENRY RD, LD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDT07290TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11144245309OTHERNPI

General Provider Information

NPI Number : 1144245309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA L MCHENRY RD, LD, CDE
Provider Business Mailing Address
First Line : 8330 LYNDON B JOHNSON FWY
Second Line : SUITE B650
City : DALLAS
State : TX
Zip : 75243-1166
Country : US
Telephone Number : 469-619-6921
Fax Number : 800-888-9560
Provider Business Practice Location Address
First Line : 8330 LYNDON B JOHNSON FWY
Second Line : SUITE B650
City : DALLAS
State : TX
Zip : 75243-1166
Country : US
Telephone Number : 469-619-6921
Fax Number : 800-888-9560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 08/19/2016

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