Governor Henry Henderson III, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN252065 Issued in GA

Practice address

75 Colonia de Salud # 200
Sierra Vista, AZ 85635-2487

Phone

(520) 263-2690

NPI assigned

Dec 4, 2018

Last updated

Apr 1, 2023By the provider in NPPES

Sex

Male

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 GA, AZ2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sierra Vista Regional Health Center Medical Group LLCGroup PAC ID 3779732854, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bayada Home Health Care, Inc Home health agency, Sierra Vista, AZ, CCN 037416
• Canyon Vista Medical Center Hospital, Sierra Vista, AZ, CCN 030043
• Benson Hospital Hospital, Benson, AZ, CCN 031301
• Copper Queen Community Hospital Hospital, Bisbee, AZ, CCN 031312

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: governor.henderson.1@19231.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sierra Vista Regional Health Center Medical Group LLC

  • Family Medicine Physician
  • Sierra Vista, AZ
  • NPI 1043575483
  Medicare reassignment Care Compare group NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD

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

• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Sierra Vista, AZ
  • NPI 1912291139
  Care Compare affiliation
• Benson Hospital Corporation

  • Critical Access Hospital
  • Benson, AZ
  • NPI 1336118322
  Care Compare affiliation
• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Sonoita Family Health

  • Rural Health Clinic/Center
  • Sonoita, AZ
  • NPI 1013160290

  Hospital

  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Canyon Vista Medical Center

  • General Acute Care Hospital
  • Sierra Vista, AZ
  • NPI 1194766543
  Care Compare affiliation
• RCHP-Sierra Vista Inc

  dba Tombstone Family Health

  • Rural Health Clinic/Center
  • Tombstone, AZ
  • NPI 1508010471

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680307200000",
    "number": "1538639497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 COLONIA DE SALUD # 200",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352487",
            "telephone_number": "520-263-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 COLONIA DE SALUD # 200",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352487",
            "telephone_number": "520-263-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "GOVERNOR",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-04",
        "last_updated": "2023-04-01",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "288860",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN252065",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "RN252065",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hearing Dynamics, LLC
• Heart and Vascular Associates LLC
• Sheila Anne Heiple, RN, BSN, MA
• Amy Marie Heise, M.A. CCC-SLP
• Helping Ourselves Pursue Enrichment, Inc. (HOPE, Inc.)
• Julie Lynn Henderson, R.D.
• Tammy Renee Heredia, RN
• Patricia E Herrewig, LPC
• Latoya Marie Herring, MEDICAL NAILTECH MNT
• Christen Herrington, CNM

• Family Nurse Practitioner in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2023; 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.