Individual
MRS. JESSICA JANE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4001 DUTCHMANS LN, LOUISVILLE, KY 40207-4714
(502) 893-1000
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3011774
KY
363LA2100X
Acute Care Nurse Practitioner
Primary
3011774
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001171998-KOHMG
ANTHEM BC/BS
KY
05
—
300024397
—
IN
05
—
7100568880
—
KY
01
—
K244160-KOHMG
KY MEDICARE
KY
Enumeration date
04/05/2018
Last updated
04/22/2024
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