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General NPI Number Information
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NPI Number | 1477029015
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Entity Type | Individual
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Provider Name | MRS. MICHELLE HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 100 COURT ST SE STE 212
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City | LIVE OAK
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State | FL
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Zip | 32064-3203
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Country | US
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Telephone | 386-209-7649
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Fax | 386-219-0222
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Provider Business Mailing Address
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Address Line | 424 MAPLE ST SW
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City | LIVE OAK
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State | FL
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Zip | 32064-3121
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Country | US
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Telephone | 386-209-7649
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Fax | 386-219-0222
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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Taxonomy #4
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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Taxonomy #6
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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