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NPI Code Detail

MEDICARE: BRANDY MICHELLE HENDERSON ARNP

MEDICARE: BRANDY MICHELLE HENDERSON ARNP
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
1363L00000XNurse Practitioner3006303KY
2363L00000XNurse Practitioner71003510AIN
3363LF0000XFamily Nurse Practitioner3006303KY
4363LF0000XFamily Nurse Practitioner71003510AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000909083OTHERKYANTHEM

General Provider Information

NPI Number : 1568791432
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY MICHELLE HENDERSON ARNP
Provider Business Mailing Address
First Line : 6200 DUTCHMANS LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-3269
Country : US
Telephone Number : 502-456-6200
Fax Number : 502-456-6655
Provider Business Practice Location Address
First Line : 6200 DUTCHMANS LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-3271
Country : US
Telephone Number : 502-456-6200
Fax Number : 502-456-6655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2009
Last Update Date : 06/01/2026

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