Individual
JUSTIN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
151 W PRAIRIE AVE, HAYDEN, ID 83835-8284
(208) 719-4880
Mailing address
151 W PRAIRIE AVE, HAYDEN, ID 83835-8284
(208) 719-4880
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
68018
ID
363LF0000X
Family Nurse Practitioner
9132375-4405
UT
Other
Enumeration date
04/07/2020
Last updated
02/22/2026
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