Courtney Lynette Henderson, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0101239024 Issued in VA

Practice address

943 Hualapai Way
Peach Springs, AZ 86434

Phone

(928) 769-2900

NPI assigned

Dec 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073678355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5327 HIGH WHEELS CT",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210445719",
            "telephone_number": "301-596-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 HUALAPAI WAY",
            "city": "PEACH SPRINGS",
            "state": "AZ",
            "postal_code": "86434",
            "telephone_number": "928-769-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "COURTNEY",
        "middle_name": "LYNETTE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101239024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn S Foster, PHARMD
• Rebecca Anne Fox, RN
• Lisa Christine Gaudet, PSY.D.
• Maria Grace Gomes
• Katrina Green
• Steven Lee Herring II
• Knesha Antonia Holden
• Hualapai Health Department
• Hualapai Tribe (Peach Springs EMS Rescue)
• Marilyn Huff, R.N.

• General Practice Physician in Peach Springs, AZ
• Providers in Peach Springs, AZ by specialty
• General Practice Physician in Arizona

• 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.

Verify at the official NPI Registry.