Kathryn Ann Henderson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO13513 Issued in OR

Practice address

19 Myrtle St
Medford, OR 97504-7337

Phone

(541) 842-7626

Fax

(541) 842-7640

NPI assigned

Apr 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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

• Ashland Emergency Associates, P.C.

  • Emergency Medicine Physician
  • Ashland, OR
  • NPI 1255393419
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363046400000",
    "number": "1710949417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047337",
            "telephone_number": "541-842-7626",
            "fax_number": "541-842-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047337",
            "telephone_number": "541-842-7626",
            "fax_number": "541-842-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KATHRYN",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2013-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "D013513",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO13513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF OREGON",
            "identifier": "023507000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "E68602",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY185059",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930079054",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "97520A005",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLAN",
            "identifier": "E68602",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hematology Oncology Pharmacy
• Henderson Behavioral Health, LLC
• Jacob James Henderson
• Jennifer Henderson, DO
• Jennifer M Henderson, MS, LPC
• Robyn M Henderson, L.M.T.
• Shannon Henderson, NP
• Sara Kay Hendricksom, PHARM D
• Kristi Noel Hennan, M.D.
• Carolyn Ann Hennessey, M.A., LMFT

• Family Medicine Physician in Medford, OR
• Providers in Medford, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.