Provider Demographics
NPI:1457920431
Name:HENSON, DESIREA CERES (APRN)
Entity Type:Individual
Prefix:
First Name:DESIREA
Middle Name:CERES
Last Name:HENSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 E 35TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2022
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-265-4480
Practice Address - Street 1:9350 E 35TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2022
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80321363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care