Lakisha Henderson, LICENSED NURSE

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

300712 Issued in TX

Practice address

2619 S. Lancaster Rd
Dallas, TX 75216

Phone

(214) 376-7388

Fax

(214) 376-7899

NPI assigned

Jul 15, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cagnolatti and Henderson Inc.

  • Methadone Clinic
  • Dallas, TX
  • NPI 1609496488
  NPD Authorized official
• Lifes Second Chance Treatment Center Lakisha Henderson Nelson Sole MBR

  • Methadone Clinic
  • Dallas, TX
  • NPI 1821419201
  NPD Authorized official

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1043651367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3543 RIO GRANDE CIR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752332553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 S. LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75216",
            "telephone_number": "214-376-7388",
            "fax_number": "214-376-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "LAKISHA",
        "credential": "LICENSED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-15",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "300712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LVN",
            "identifier": "300712",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lifessecondchance01@gmail.com",
            "affiliation": "N",
            "address_1": "2619 S. Lancaster Rd",
            "city": "dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "75216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jonathan Henderson, PHARMD
• Kamilah Dionne Henderson, CNNP
• Karen Henderson, MS/CCC-SLP
• Katherine Yvette Henderson
• Kathy Jo Henderson, CHW
• Lydia Gray Henderson, MSW
• Marlon Henderson
• Marsha Carroll Henderson, SLP
• Michael D Henderson, MD
• Robert J Henderson, M.D.

• Addiction (Substance Use Disorder) Registered Nurse in Dallas, TX
• Providers in Dallas, TX by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.