Healthcare Provider Details

I. General information

NPI: 1780315382
Provider Name (Legal Business Name): KARI JANE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DERR RD UNIT A
SPRINGFIELD OH
45503-2439
US

IV. Provider business mailing address

6201 STATE ROUTE 56
MECHANICSBURG OH
43044-9719
US

V. Phone/Fax

Practice location:
  • Phone: 937-629-0100
  • Fax: 937-629-3285
Mailing address:
  • Phone: 765-432-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: