Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 005282 | MO |
NPI | 1285787903 |
---|---|
Provider Name | Dr. Christy M Henley |
First Address | Columbia, MO 65203-6322 |
Second Address | Columbia, MO 65203-6322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108348A | BLUE CROSS BLUE SHIELD (01) | MO |
431418200 | (02) | MO |