Individual provider Active NPI

Journey Lucian Henderson, FNP-BC

  • Family Nurse Practitioner
National Provider Identifier
1558763300
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19047 Issued in SC
Practice address
Landstuhl Regional Medical Center
Unit 33100
Apo, AE 09180-3100
Phone
(314) 590-7028
NPI assigned
Sep 24, 2014
Last updated
Jan 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 209379 SC
Family Nurse Practitioner 363LF0000X 19047 SC Primary

Addresses

Primary practice location

Landstuhl Regional Medical Center
Unit 33100
Apo, AE 09180-3100

Mailing address

Landstuhl Regional Medical Center
Unit 33100
Apo, AE 09180-3100

Other practice location 1

316 Calhoun St
Charleston, SC 29401-1113
Phone (843) 724-2000

Other identifiers 1

IdentifierTypeStateIssuer
NP3104MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NY2 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

Enrollment IDStateProvider typePAC IDDetails
I20150121001363 SC Practitioner - Nurse Practitioner 1658695796 Reassigns benefits to 2 organizations
I20191007001256 NY Practitioner - Nurse Practitioner 1658695796 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209379SCMDRegistered Nurse
19047SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roper Saint Francis Physicians Network Current Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Oct 28, 2019 Accepting new patients
24 On Physicians of SC, LLC CurrentSince Jan 1, 2020 Accepting new patients
Rochester General Hospital CurrentSince Aug 20, 2019 Accepting new patients
Newark Wayne Community Hospital CurrentSince Aug 20, 2019 Accepting new patients
Rochester General Hospital CurrentSince Aug 20, 2019 Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Aug 20, 2019 Accepting new patients
Newark Wayne Community Hospital CurrentSince Aug 20, 2019 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Oct 28, 2019 Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

1200 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2170

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

2075 Eagle Landing Blvd
North Charleston, SC 29406
Phone (843) 797-5747

Interoperability endpoints

  • Direct secure messaging: jhenderson1252195@direct.bsmhealth.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1558763300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "LANDSTUHL REGIONAL MEDICAL CENTER",
            "address_2": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "LANDSTUHL REGIONAL MEDICAL CENTER",
            "address_2": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100",
            "telephone_number": "314-590-7028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "316 Calhoun St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294011113",
            "country_code": "US",
            "telephone_number": "843-724-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JOURNEY",
        "middle_name": "LUCIAN",
        "name_prefix": "Dr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-24",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "209379",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3104",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.