Healthcare Provider Details

I. General information

NPI: 1811375207
Provider Name (Legal Business Name): KEVIN L HENDRICKSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S ORANGE AVE
ORLANDO FL
32806-1226
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax: 603-952-3900
Mailing address:
  • Phone: 812-426-9355
  • Fax: 812-858-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28157005A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005723A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11037740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: