Provider Demographics
NPI:1265457907
Name:HENDERSON, JAMES ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2327
Mailing Address - Country:US
Mailing Address - Phone:859-887-2484
Mailing Address - Fax:859-885-8448
Practice Address - Street 1:110 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2327
Practice Address - Country:US
Practice Address - Phone:859-887-2484
Practice Address - Fax:859-885-8448
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GRP
GACB5773OtherRR MEDICARE GRP
KY37903705OtherMEDICAID LAB GRP
KY64198914Medicaid
KY0225304Medicare ID - Type Unspecified
KY37903705OtherMEDICAID LAB GRP