# JUSTIN HENDERSON

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

## Provider details

- **NPI number:** 1770112138
- **Gender:** Man
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 68018 | ID | Yes |
| 363LF0000X | Family Nurse Practitioner | 9132375-4405 | UT | — |

## Other

- **Enumeration date:** 04/07/2020
- **Last updated:** 02/22/2026