Frederick G Henderson Jr.
Individual provider Active NPI Homemaker · Florissant, MO
NPI 1679420178 · NPPES record last updated Mar 13, 2026
Key facts
- NPI
- 1679420178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- License
- LCO14715385 (MO)
- Practice address
- 2345 Cardinal Dr
Florissant, MO 63033-2025 - Phone
- (314) 598-1058
- NPI assigned
- Mar 13, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCO14715385 | MO | MD | Homemaker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker |
376J00000X | LCO14715385 | MO | Yes |
Addresses
Primary practice location
2345 Cardinal Dr
Florissant, MO 63033-2025
Mailing address
2345 Cardinal Dr
Florissant, MO 63033-2025
Phone (314) 598-1058
Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.