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General NPI Number Information
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NPI Number | 1316452253
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Entity Type | Individual
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Provider Name | BRANDY DAVINA HENDERSON RN,FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 09/15/2024
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Provider Practice Location Address
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Address Line | 4950 NORTHCUTT PL
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City | DAYTON
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State | OH
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Zip | 45414-3840
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Country | US
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Telephone | 937-496-2020
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Fax | 937-496-2016
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Provider Business Mailing Address
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Address Line | 9775 COLERAIN AVE
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City | CINCINNATI
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State | OH
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Zip | 45251-1442
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Country | US
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Telephone | 513-853-9700
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Fax | 513-852-8971
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RP277614
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.026361
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP.026361
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License Number State | OH
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