Kywina Marie Henderson, FNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

17177 Issued in CA

Practice address

13425 Ventura Blvd Ste 201
Sherman Oaks, CA 91423-3974

Phone

(818) 305-6061

NPI assigned

Jun 6, 2007

Last updated

Jun 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Kywina Marie Cannon Other name

Medicare fee-for-service enrollment

Enrolled in CA, WA2 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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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.

• Kywina M Henderson Professional Advanced Practice Nursing Corporat

  dba All Kynd Behavioral Health & Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Vancouver, WA
  • NPI 1548049265
  Medicare reassignment NPD Authorized official
• K Somanath MD Inc

  dba Psychiatry Treatment Centers

  • Psychiatry Physician
  • Los Angeles, CA
  • NPI 1649998022

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Mellow Medical Inc a Professional Corporation

  • Psychiatry Physician
  • West Hollywood, CA
  • NPI 1407275886
  Medicare reassignment NPD
• Telecare Corporation

  dba Gateway To Recovery

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1720164882
  Medicare reassignment NPD
• Java Psychiatry Inc

  • Neurology Physician
  • Sherman Oaks, CA
  • NPI 1265728448
  NPD
• Telecare Corporation

  dba Valley Vista Permanent Supportive Housing

  • Mental Illness Community Based Residential Treatment Facility
  • San Diego, CA
  • NPI 1275398935
  NPD
• Telecare Corporation

  dba Telecare la Jimhcs

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Fe SPGS, CA
  • NPI 1962247296
  NPD

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1609079839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 VERMONT PL",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917681461",
            "telephone_number": "909-788-4638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13425 VENTURA BLVD STE 201",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914233974",
            "telephone_number": "818-305-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KYWINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "FNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-06",
        "last_updated": "2022-06-21",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "17177",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "17177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYWINA",
            "last_name": "CANNON",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "FNP, PMHNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Wynn Helms
• Parmida Hemati
• Reyahna Carra Hemerson I
• Daniel Hemmati, D.D.S.
• Brittney Clarisse Henderson, LMFT
• Alvin W Hendon Sr.
• Arnoldo Marquinho Henriquez, BCBA
• Henry Kang Acupuncture Clinic Inc
• Antasia M Henry
• Thomas S Hensley, MA, AMFT

• Psychiatric/Mental Health Nurse Practitioner in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.