Provider Demographics
NPI:1326159245
Name:HENDRICKS, LAURAIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURAIN
Middle Name:C
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3821
Practice Address - Country:US
Practice Address - Phone:660-310-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004001454207Q00000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1213919OtherUHC
289909OtherGHP
1507739OtherCIGNA
MO208437103Medicaid
442236OtherHEALTHLINK
214436OtherANTHEM BCBS MO
F78404OtherMERCY
50025OtherHC USA
4524214OtherAETNA
4524214OtherAETNA
442236OtherHEALTHLINK