Provider Demographics
NPI:1457486862
Name:HENDERSON, ROBERT T (RN,CRNFA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:RN,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 TODDS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9442
Mailing Address - Country:US
Mailing Address - Phone:859-552-6398
Mailing Address - Fax:859-263-7724
Practice Address - Street 1:1740 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1431
Practice Address - Country:US
Practice Address - Phone:859-552-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1035215163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1188196OtherCHA
000000186247Medicare UPIN
1188196Medicare UPIN
49-00010Medicare UPIN