Healthcare Provider Details

I. General information

NPI: 1861274383
Provider Name (Legal Business Name): HENDERSON KNEE AND JOINT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 SAINT ROSE PKWY STE 335
HENDERSON NV
89074-7794
US

IV. Provider business mailing address

2580 SAINT ROSE PKWY STE 335
HENDERSON NV
89074-7794
US

V. Phone/Fax

Practice location:
  • Phone: 435-319-8371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SHERRIE GARDUNO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 435-319-8371