Active NPI
Kammi Mignon Henderson, PHARM.D.
- Pharmacist
- Macclenny, FL
National Provider Identifier
1376145383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS36881
- Practice address
- 9218 S, FL-228
Macclenny, FL 32063 - Phone
- (904) 259-3860
- NPI assigned
- Nov 13, 2020
- Last updated
- Nov 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS36881 | FL | Primary |
Addresses
Primary practice location
9218 S, FL-228
Macclenny, FL 32063
Mailing address
4282 Broad Creek LN
Jacksonville, FL 32218-9146
Phone (904) 476-4289
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 |
|---|---|---|---|
| PS36881 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605225600000",
"number": "1376145383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4282 BROAD CREEK LN",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322189146",
"telephone_number": "904-476-4289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9218 S, FL-228",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "32063",
"telephone_number": "904-259-3860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KAMMI",
"middle_name": "MIGNON",
"name_prefix": "Mrs.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-13",
"last_updated": "2020-11-13",
"certification_date": "2020-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS36881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.