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NPI Code Detail

MEDICARE: KAREN HENDERSON MD

MEDICARE: KAREN HENDERSON MD
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
1208000000XPediatrics PhysicianMD00046368WA
2208M00000XHospitalist PhysicianMD00046368WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831193747
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN HENDERSON MD
Provider Business Mailing Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4445
Country : US
Telephone Number : 509-525-3720
Fax Number : 509-522-1578
Provider Business Practice Location Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4445
Country : US
Telephone Number : 509-525-3720
Fax Number : 509-522-1578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 03/10/2022

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