Kimberly Ann Henderson, MA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06963 Issued in NC

Practice address

501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035

Phone

(704) 377-2424

Fax

(704) 377-2687

NPI assigned

Nov 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mid-Atlantic Emergency Medical Associates PLLCGroup PAC ID 4880686823, 100 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
• Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195

Merit-based Incentive Payment System (MIPS)

Final score

84.97 of 100Reported as group

Quality

79.68

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

Practice roles

Locations

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.

• Mid-Atlantic Emergency Medical Associates, PLLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1073562757
  Medicare reassignment Care Compare group
• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Gastonia, NC
  • NPI 1316367691
  Medicare reassignment
• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Belmont, NC
  • NPI 1104644004
  NPD
• Mema SC LLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1407675176
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Novant Health Ballantyne Medical Center LLC

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1740998020
  Care Compare affiliation
• Novant Health Matthews Medical Center LLC

  • General Acute Care Hospital
  • Matthews, NC
  • NPI 1063463156
  Care Compare affiliation

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1538340641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-06963",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deana Elizabeth Henderson, FNP
• Geneva Antionette Henderson, LPC
• Jasona Henderson
• Kathryn Henderson, FNP
• Kenya Henderson
• Kristen Michelle Henderson
• Laurdes Blanca Henderson, MS, LCMHCA
• Melissa Y Henderson
• Olivia Marie Henderson
• Regina L. Henderson, D.D.S

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.