Active NPI
Kenneth J Henderson, LAT, ATC
- Athletic Trainer
- Great Bend, KS
National Provider Identifier
1023046497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 24-00048
- Practice address
- 245 NE 30 Rd
Great Bend, KS 67530-9251 - Phone
- (620) 792-9371
- Fax
- (620) 786-1161
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 24-00048 | KS | Primary |
Addresses
Primary practice location
245 NE 30 Rd
Great Bend, KS 67530-9251
Mailing address
245 NE 30 Rd
Great Bend, KS 67530-9251
Phone (620) 792-9371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PROVIDER CODE 22 | Other | KS | REHAB. & RESTORATIVE SERV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-00048 | KS | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023046497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 NE 30 RD",
"city": "GREAT BEND",
"state": "KS",
"postal_code": "675309251",
"telephone_number": "620-792-9371",
"fax_number": "620-786-1161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 NE 30 RD",
"city": "GREAT BEND",
"state": "KS",
"postal_code": "675309251",
"telephone_number": "620-792-9371",
"fax_number": "620-786-1161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KENNETH",
"middle_name": "J",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KS",
"license": "24-00048",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REHAB. & RESTORATIVE SERV",
"identifier": "PROVIDER CODE 22",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Bend, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.