Provider Demographics
NPI:1932461225
Name:HENDERSON, MAGAN GOFF (RN, APN)
Entity Type:Individual
Prefix:MRS
First Name:MAGAN
Middle Name:GOFF
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:MISS
Other - First Name:MAGAN
Other - Middle Name:MICHELLE
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APN
Mailing Address - Street 1:1421 W BADDOUR PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2652
Mailing Address - Country:US
Mailing Address - Phone:615-449-6780
Mailing Address - Fax:615-449-1929
Practice Address - Street 1:1421 W BADDOUR PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2652
Practice Address - Country:US
Practice Address - Phone:615-449-6780
Practice Address - Fax:615-449-1929
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014885363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology