Individual provider Active NPI

Kelly L Henderson, CMS, QMHS, RA

  • Case Manager/Care Coordinator
  • Youngstown, OH
National Provider Identifier
1043153729
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
527 N Meridian Rd
Youngstown, OH 44509-1227
Phone
(330) 797-0070
Fax
(330) 797-9146
NPI assigned
Apr 9, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X OH Primary
Prevention Professional 405300000X RA.164902 OH
Community Health Worker 172V00000X OH

Addresses

Primary practice location

527 N Meridian Rd
Youngstown, OH 44509-1227

Mailing address

527 N Meridian Rd
Youngstown, OH 44509-1227
Phone (330) 797-0070

Other practice location 1

320 High St NE
Warren, OH 44481-1222
Phone (330) 797-0070

Other practice location 2

550 W Chalmers Ave
Youngstown, OH 44511-1576
Phone (330) 797-0070

Other practice location 3

8255 South Ave
Youngstown, OH 44512-6483
Phone (330) 797-0070

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1775692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1043153729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 N MERIDIAN RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445091227",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 N MERIDIAN RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445091227",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 High St NE",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444811222",
            "country_code": "US",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 W Chalmers Ave",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445111576",
            "country_code": "US",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8255 South Ave",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445126483",
            "country_code": "US",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "CMS, QMHS, RA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-09",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OH",
            "license": "RA.164902",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.