| Doctor Name: | MRS. AMY HENDERSON |
| NPI Number: | 1821499153 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, MS, LD |
| License Number: | 1719 |
| Business Practice Address: | 10306 N 138th East Ave Suite 204 Owasso, OK - 740554665 |
| Business Phone Number: | 9184010006 |
| Business Fax Number: | 8773804628 |
| Mailing Address: | 5662 S 83rd East Ave, TULSA |
| State: | OK |
| Postal Code: | 741457922 |
| Phone Number: | 9189025611 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2014 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1719 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |