Active NPI
Kaylin S Henderson, PT
- Physical Therapist
- Fort Bayard, NM
National Provider Identifier
1124225339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2112
- Practice address
- 100 Calle El Centro
Fort Bayard, NM 88036 - Phone
- (505) 537-8782
- Fax
- (505) 537-2167
- NPI assigned
- Jun 29, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2112 | NM | Primary |
Addresses
Primary practice location
100 Calle El Centro
Fort Bayard, NM 88036
Mailing address
PO Box 36219
100 Calle El Centro
Fort Bayard, NM 88036
Phone (505) 537-8782
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62974068 | Medicaid | NM |
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 |
|---|---|---|---|
| 2112 | NM | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New Mexico | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Department of Health Family Planning
- Public Health or Welfare Agency
- Santa Fe, NM
- NPI 1134257249
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124225339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 36219",
"address_2": "100 CALLE EL CENTRO",
"city": "FORT BAYARD",
"state": "NM",
"postal_code": "88036",
"telephone_number": "505-537-8782",
"fax_number": "505-537-2167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CALLE EL CENTRO",
"city": "FORT BAYARD",
"state": "NM",
"postal_code": "88036",
"telephone_number": "505-537-8782",
"fax_number": "505-537-2167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KAYLIN",
"middle_name": "S",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "2112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "62974068",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Bayard, NM
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.