Active NPI
Kellie N Henderson, PHARMD, BCNSP
- Nutrition Support Pharmacist
- Miami, FL
National Provider Identifier
1184850984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- PS28015
- Practice address
- 1611 NW 12TH Ave
Et-B069
Miami, FL 33136-1005 - Phone
- (305) 585-6651
- NPI assigned
- Jun 8, 2009
- 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 |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | PS28015 | FL | Primary |
Addresses
Primary practice location
1611 NW 12TH Ave
Et-B069
Miami, FL 33136-1005
Mailing address
1611 NW 12TH Ave
Et-B069
Miami, FL 33136-1005
Phone (305) 585-6651
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS28015 | FL | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244419200000",
"number": "1184850984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 NW 12TH AVE",
"address_2": "ET-B069",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "305-585-6651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 NW 12TH AVE",
"address_2": "ET-B069",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "305-585-6651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KELLIE",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "PHARMD, BCNSP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-08",
"last_updated": "2009-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "FL",
"license": "PS28015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.