Healthcare Provider Details

I. General information

NPI: 1457486862
Provider Name (Legal Business Name): ROBERT T HENDERSON RN,CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

4820 TODDS RD
LEXINGTON KY
40509-9442
US

V. Phone/Fax

Practice location:
  • Phone: 859-552-6398
  • Fax:
Mailing address:
  • Phone: 859-552-6398
  • Fax: 859-263-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1035215
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: