Individual
JOLETTA KEMP HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6393 GREEN GROVE DR, MEMPHIS, TN 38141-7158
(901) 282-7738
Mailing address
6393 GREEN GROVE DR, MEMPHIS, TN 38141-7158
(901) 282-7738
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
64592
TN
171WH0202X
Home Modifications Contractor
Primary
64592
TN
225200000X
Physical Therapy Assistant
PTA 1579
AR
225200000X
Physical Therapy Assistant
PTA4329
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q057969
—
TN
Enumeration date
03/31/2011
Last updated
08/17/2021
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