Provider Demographics
NPI:1366866139
Name:HENDERSON, CHRISTINA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4711 CENTERLINE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1403
Mailing Address - Country:US
Mailing Address - Phone:865-545-8700
Mailing Address - Fax:865-545-8704
Practice Address - Street 1:4711 CENTERLINE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1403
Practice Address - Country:US
Practice Address - Phone:865-545-8700
Practice Address - Fax:865-545-8704
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000002437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant