Provider Demographics
NPI:1396825303
Name:HENDERSON, HILARI M (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:HILARI
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:HILARI
Other - Middle Name:M
Other - Last Name:DITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:960 E WALNUT LAWN
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-4450
Practice Address - Fax:417-269-8333
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000097362Medicare PIN
Q74210Medicare UPIN