Healthcare Provider Details

I. General information

NPI: 1679846570
Provider Name (Legal Business Name): SCOTT THOMAS HENDERSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DES PERES RD STE 110
SAINT LOUIS MO
63131-2050
US

IV. Provider business mailing address

5342 CHERRYVIEW LN
SAINT LOUIS MO
63128-3728
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-8880
  • Fax:
Mailing address:
  • Phone: 314-709-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026029340
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: