MEDICARE: BRANDY DAVINA HENDERSON RN,FNP, PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.026361	OH
2	163WG0000X	General Practice Registered Nurse	RP277614	OH
3	363LF0000X	Family Nurse Practitioner	CNP.026361	OH

General Provider Information

NPI Number	:	1316452253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY DAVINA HENDERSON RN,FNP, PMHNP

Provider Business Mailing Address
First Line	:	9775 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1442
Country	:	US
Telephone Number	:	513-853-9700
Fax Number	:	513-852-8971

Provider Business Practice Location Address
First Line	:	4950 NORTHCUTT PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3840
Country	:	US
Telephone Number	:	937-496-2020
Fax Number	:	937-496-2016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	02/23/2026

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