Provider Demographics
NPI:1669007332
Name:HENDERSON, RACHEL (CNM)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BURKARTH RD STE A
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3120
Mailing Address - Country:US
Mailing Address - Phone:660-429-2228
Mailing Address - Fax:
Practice Address - Street 1:415 BURKARTH RD STE A
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3120
Practice Address - Country:US
Practice Address - Phone:660-429-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70824163WX0003X
NM778176B00000X
MO2021007301367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70824OtherRN
CNM05823OtherAMCB CERTIFICATION
MO2021007301OtherAPRN-CNM
NM778OtherCNM LICENSE