Provider Demographics
NPI:1821063652
Name:HENRIKSON, JODI (MD)
Entity Type:Individual
Prefix:MR
First Name:JODI
Middle Name:
Last Name:HENRIKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:HENRIKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:514 CLEVELAND ST
Mailing Address - Street 2:MEDICAL PAVILION
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3562
Mailing Address - Country:US
Mailing Address - Phone:620-792-2151
Mailing Address - Fax:620-860-0305
Practice Address - Street 1:514 CLEVELAND ST
Practice Address - Street 2:MEDICAL PAVILION
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3562
Practice Address - Country:US
Practice Address - Phone:620-792-2151
Practice Address - Fax:620-860-0305
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology