Provider Demographics
NPI:1043901028
Name:HENDERSON, DESTINEE KAPREE
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:KAPREE
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 1:9601 RUNNING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3925
Mailing Address - Country:US
Mailing Address - Phone:804-381-7445
Mailing Address - Fax:
Practice Address - Street 1:8809B CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3134
Practice Address - Country:US
Practice Address - Phone:804-381-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program