Healthcare Provider Details

I. General information

NPI: 1023951811
Provider Name (Legal Business Name): RACHEL ELIZABETH HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
LOUISIANA MO
63353-2000
US

IV. Provider business mailing address

6500 HOSPITAL DR
HANNIBAL MO
63401-6890
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5555
  • Fax: 573-754-5932
Mailing address:
  • Phone: 573-629-5140
  • Fax: 573-629-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026031346
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2016035017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: