Provider Demographics
NPI:1033131867
Name:HENDERSON, CAROL A (MSN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:KAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-843-8051
Mailing Address - Fax:717-848-2578
Practice Address - Street 1:1777 5TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2632
Practice Address - Country:US
Practice Address - Phone:717-843-8051
Practice Address - Fax:717-848-2578
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289656L163W00000X
PASP007901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1551816OtherGATEWAY MEDICARE ASSURED
PA1587160OtherHIGHMARK BLUE SHIELD FREEDOM BLUE
PASP007901OtherMEDICAL LICENSE NUMBER
PA1551816OtherGATEWAY MEDICARE ASSURED
PA075231EZ3Medicare PIN
PAQ02546Medicare UPIN