Micah Jayne Henderson, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

719 N William Kumpf Blvd Ste 300
Peoria, IL 61605-2531

Phone

(309) 495-4530

NPI assigned

Dec 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1851107676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 N WILLIAM KUMPF BLVD STE 300",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 N WILLIAM KUMPF BLVD STE 300",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052531",
            "telephone_number": "309-495-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICAH",
        "middle_name": "JAYNE",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-06",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Killian Hender, DC
• Caleb Graham Henderson, MD
• Devin Patricia Henderson, LCSW
• Heidi Henderson, PA
• Melinda Henderson, C-FNP
• Michala Henderson, DO
• Amber Hendricks
• Kathleen Marie Hendricks, APN
• Samuel Hendricks, DC
• David K Hendricksen, M.D.

• Registered Dietitian in Peoria, IL
• Providers in Peoria, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.