Healthcare Provider Details

I. General information

NPI: 1902111503
Provider Name (Legal Business Name): JONI KAY HENDERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 1ST ST E
INDEPENDENCE IA
50644-3155
US

IV. Provider business mailing address

1600 1ST ST E
INDEPENDENCE IA
50644-3155
US

V. Phone/Fax

Practice location:
  • Phone: 319-332-0999
  • Fax:
Mailing address:
  • Phone: 319-332-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA075433
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: