Provider Demographics
NPI:1942270517
Name:HENDERSON, CHRISTA RHODES (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:RHODES
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5231 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9143
Mailing Address - Country:US
Mailing Address - Phone:225-769-0933
Mailing Address - Fax:225-769-6255
Practice Address - Street 1:8888 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3772
Practice Address - Country:US
Practice Address - Phone:225-769-0933
Practice Address - Fax:225-769-6255
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200028.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628719Medicaid
LA1628719Medicaid
LA402792YH3VMedicare PIN
MS02525245Medicaid