Individual
KIMBERLY JILL HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
334 PLAZA RD, KINGSTON, NY 12401-2975
(845) 338-5575
Mailing address
1351 ROUTE 55, SUITE 200, LAGRANGEVILLE, NY 12540-5108
(845) 475-9661
(845) 475-9938
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
278817
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04091058
—
NY
Enumeration date
06/17/2011
Last updated
01/24/2017
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