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NPI Code Detail

MEDICARE: MS. KATHERYN LOUISE HENNINGER PMHNP

MEDICARE: MS. KATHERYN LOUISE HENNINGER 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner087000310N6OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497842710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHERYN LOUISE HENNINGER PMHNP
Provider Business Mailing Address
First Line : 36 SW NYE ST
Second Line :
City : NEWPORT
State : OR
Zip : 97365-3821
Country : US
Telephone Number : 541-265-0445
Fax Number : 844-760-0526
Provider Business Practice Location Address
First Line : 51 SW LEE ST
Second Line :
City : NEWPORT
State : OR
Zip : 97365-3823
Country : US
Telephone Number : 541-574-5960
Fax Number : 844-760-0526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 05/13/2021

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