Provider Demographics
NPI:1538639497
Name:HENDERSON, GOVERNOR HENRY III (DNP)
Entity type:Individual
Prefix:DR
First Name:GOVERNOR
Middle Name:HENRY
Last Name:HENDERSON
Suffix:III
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 COLONIA DE SALUD # 200
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2487
Mailing Address - Country:US
Mailing Address - Phone:520-263-2690
Mailing Address - Fax:
Practice Address - Street 1:75 COLONIA DE SALUD # 200
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2487
Practice Address - Country:US
Practice Address - Phone:520-263-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252065208800000X, 363LF0000X
AZ288860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208800000XAllopathic & Osteopathic PhysiciansUrology