Provider Demographics
NPI:1013583012
Name:HENDERSON, THERESA SUE (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:SUE
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 1:10 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-6024
Mailing Address - Country:US
Mailing Address - Phone:606-376-5363
Mailing Address - Fax:606-376-9919
Practice Address - Street 1:10 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-6024
Practice Address - Country:US
Practice Address - Phone:606-376-5363
Practice Address - Fax:606-376-9919
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily