Active NPI
Yvette Henderson, RDN
- Registered Dietitian
- West Jordan, UT
National Provider Identifier
1225403322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86032429
- Practice address
- 3580 W 9000 S
West Jordan, UT 84088-8812 - Phone
- (801) 964-3855
- NPI assigned
- Dec 1, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86032429 | IL | Primary |
Addresses
Primary practice location
3580 W 9000 S
West Jordan, UT 84088-8812
Mailing address
7473 Shay LN
South Weber, UT 84405-9202
Phone (801) 920-7050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62-1801973 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86032429 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448928000000",
"number": "1225403322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7473 SHAY LN",
"city": "SOUTH WEBER",
"state": "UT",
"postal_code": "844059202",
"telephone_number": "801-920-7050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3580 W 9000 S",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "840888812",
"telephone_number": "801-964-3855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "YVETTE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-01",
"last_updated": "2015-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "86032429",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "62-1801973",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.