Provider Demographics
NPI:1780315382
Name:HENDERSON, KARI JANE
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:JANE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 STATE ROUTE 56
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9719
Mailing Address - Country:US
Mailing Address - Phone:765-432-7988
Mailing Address - Fax:
Practice Address - Street 1:2355 DERR RD UNIT A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2439
Practice Address - Country:US
Practice Address - Phone:937-629-0100
Practice Address - Fax:937-629-3285
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily