Individual
KATHLEEN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CRNP
Contact information
Practice address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 707-3677
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 453-3300
(215) 453-3306
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
VP004751X
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022773590001
—
PA
Enumeration date
06/27/2007
Last updated
04/30/2018
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