Provider Demographics
NPI:1144505629
Name:HENDERSON, ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 COLLINS LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8610
Mailing Address - Country:US
Mailing Address - Phone:606-619-8459
Mailing Address - Fax:800-804-3513
Practice Address - Street 1:376 COLLINS LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8610
Practice Address - Country:US
Practice Address - Phone:606-619-8459
Practice Address - Fax:800-804-3513
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner