Provider Demographics
NPI:1174113849
Name:COREY HENDERSON NP, INC
Entity type:Organization
Organization Name:COREY HENDERSON NP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-202-6301
Mailing Address - Street 1:6801 US HIGHWAY 27 N STE B1
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1000
Mailing Address - Country:US
Mailing Address - Phone:863-591-2273
Mailing Address - Fax:863-591-2273
Practice Address - Street 1:6801 US HIGHWAY 27 N STE B1
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1000
Practice Address - Country:US
Practice Address - Phone:593-591-2273
Practice Address - Fax:636-585-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care