Provider Demographics
NPI:1174883292
Name:HENDERSON, CORY RYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:RYAN
Last Name:HENDERSON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:57950 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3505
Mailing Address - Country:US
Mailing Address - Phone:316-759-5120
Mailing Address - Fax:316-759-6553
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3505
Practice Address - Country:US
Practice Address - Phone:316-759-5120
Practice Address - Fax:316-759-6553
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2022-08-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical