# TINA R HENDRICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538241104
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 01059551 | IN | — |
| 207V00000X | Obstetrics & Gynecology Physician | 01059551A | IN | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 56655 | KY | — |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 04/03/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 090540768 | MEDICARE PTAN | IN |
| 05 | — | 200945900A | — | IN |
| 01 | — | 50015141 | KY PASSPORT | KY |
| 01 | — | 521891 | ANTHEM | IN |
| 05 | — | 7100017830 | — | KY |
| 01 | — | 744915 | AETNA | IN |