Joletta Kemp Henderson

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

License

64592 Issued in TN

Practice address

6393 Green Grove Dr
Memphis, TN 38141-7158

Phone

(901) 282-7738

NPI assigned

Mar 31, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 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.

• Joletta K. Henderson

  • Physical Therapist
  • Memphis, TN
  • NPI 1467874321

  Single Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1154610152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6393 GREEN GROVE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381417158",
            "telephone_number": "901-282-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6393 GREEN GROVE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381417158",
            "telephone_number": "901-282-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JOLETTA",
        "middle_name": "KEMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "TN",
            "license": "64592",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA 1579",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA4329",
            "primary": false
        },
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "TN",
            "license": "64592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q057969",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dejuna Latrice Henderson
• Ellena Henderson, MD
• Jenae Henderson, FNP-C
• Jennifer H Henderson, O.T.
• Jerrika Olivia Henderson, DBH
• Kelsey Henderson, DO
• Kimberly Faith Henderson, NCC, LPC-MHSP (TEMP)
• Lauren Henderson, D.O.
• Lauren Alyssia Henderson
• Mahogany Brandia Henderson, B.A.

• Home Modifications Contractor in Memphis, TN
• Providers in Memphis, TN by specialty
• Home Modifications Contractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.