Healthcare Provider Details

I. General information

NPI: 1689508350
Provider Name (Legal Business Name): DANIEL GRANT HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

525 HIGHWAY 36
FRENCHBURG KY
40322-8121
US

V. Phone/Fax

Practice location:
  • Phone: 185-923-3451
  • Fax:
Mailing address:
  • Phone: 859-697-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number1100120
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number1100120
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number1100120
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: