Provider Demographics
NPI:1255589909
Name:HENDERSON, HEATHER K (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:K
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:1045 JAMES ST
Mailing Address - Street 2:BROWNELL CENTER FOR BEHAVIORAL HEALTH
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2730
Mailing Address - Country:US
Mailing Address - Phone:315-472-4471
Mailing Address - Fax:315-422-4855
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:BROWNELL CENTER FOR BEHAVIORAL HEALTH
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2730
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:315-422-4855
Is Sole Proprietor?:No
Enumeration Date:2008-09-07
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY552060163W00000X
NYF401141363LP0808X
NYF401141-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner