Provider Demographics
NPI:1649898230
Name:HENDERSON, LINDA JO
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JO
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3530
Mailing Address - Country:US
Mailing Address - Phone:318-478-0348
Mailing Address - Fax:318-299-8218
Practice Address - Street 1:1375 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3530
Practice Address - Country:US
Practice Address - Phone:318-478-0348
Practice Address - Fax:318-299-8218
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant