Individual
DR. KEITH HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 609-4592
(910) 609-5179
Mailing address
1638 OWEN DRIVE, ATTN: MANAGED CARE PLANNING, FAYETTEVILLE, NC 28304
(910) 615-6949
(910) 615-9761
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
9400073
NC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
9400073
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8941399
—
NC
Enumeration date
05/04/2006
Last updated
07/15/2015
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