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NPI Code Detail

MEDICARE: MRS. JENNIFER LYNNE HENDERSON FNP

MEDICARE: MRS. JENNIFER LYNNE HENDERSON FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3011474KY

General Provider Information

NPI Number : 1023532397
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LYNNE HENDERSON FNP
Provider Business Mailing Address
First Line : 200 BLUEBILL CT
Second Line :
City : SHEPHERDSVILLE
State : KY
Zip : 40165-8362
Country : US
Telephone Number : 502-303-6696
Fax Number :
Provider Business Practice Location Address
First Line : 810 S MAIN ST
Second Line :
City : ELKTON
State : KY
Zip : 42220-8812
Country : US
Telephone Number : 270-265-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2017
Last Update Date : 07/28/2017

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