Cory Ryan Henderson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

57950 Leavenworth St
McConnell AFB, KS 67221-3505

Phone

(316) 759-5120

Fax

(316) 759-6553

NPI assigned

May 23, 2012

Last updated

Aug 15, 2022By the provider in NPPES

Sex

Male

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1174883292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57950 LEAVENWORTH ST",
            "city": "MCCONNELL AFB",
            "state": "KS",
            "postal_code": "672213505",
            "telephone_number": "316-759-5120",
            "fax_number": "316-759-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57950 LEAVENWORTH ST",
            "city": "MCCONNELL AFB",
            "state": "KS",
            "postal_code": "672213505",
            "telephone_number": "316-759-5120",
            "fax_number": "316-759-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "CORY",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Hatchett, PSYD
• Cody Lee Hattenberger, PHARM.D
• Maribeth Havran, DIETITIAN
• Gary C Hawley, PSY.D.
• Jeffrey Scott Hayes, RN
• Loralie Ellington Hodges, O.D.
• Dorothy A Hogg, WHCNP
• Ty Hunt, MPT
• Cory J Jacobsen, MD
• Timothy Edward Jankowski, DDS

• Medical Physician Assistant in McConnell AFB, KS
• Providers in McConnell AFB, KS by specialty
• Medical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.