Active NPI
Lisa Marie Henson, PA-C
- Physician Assistant
- Cooperstown, NY
National Provider Identifier
1689765018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0114871
- Practice address
- 1 Atwell Rd
Cooperstown, NY 13326-1301 - Phone
- (607) 547-6982
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0114871 | NY | Primary |
Addresses
Primary practice location
1 Atwell Rd
Cooperstown, NY 13326-1301
Mailing address
787 County Highway 54
Cherry Valley, NY 13320-2003
Phone (518) 588-0866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011487 | NY | MD | Occupational Therapy Assistant |
| 0114871 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239062400000",
"number": "1689765018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "787 COUNTY HIGHWAY 54",
"city": "CHERRY VALLEY",
"state": "NY",
"postal_code": "133202003",
"telephone_number": "518-588-0866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 ATWELL RD",
"city": "COOPERSTOWN",
"state": "NY",
"postal_code": "133261301",
"telephone_number": "607-547-6982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSON",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2009-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "0114871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cooperstown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.