Active NPI
Kiersten Collette Henderson
- Social Worker
- Fargo, ND
National Provider Identifier
1811609043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6470
- Practice address
- 1202 Westrac Dr S
Fargo, ND 58103-2338 - Phone
- (701) 280-9545
- NPI assigned
- Dec 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Social Worker | 104100000X | 6470 | ND | Primary |
Addresses
Primary practice location
1202 Westrac Dr S
Fargo, ND 58103-2338
Mailing address
1202 Westrac Dr S
Fargo, ND 58103-2338
Phone (701) 280-9545
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6470 | ND | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1811609043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 WESTRAC DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581032338",
"telephone_number": "701-280-9545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 WESTRAC DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581032338",
"telephone_number": "701-280-9545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KIERSTEN",
"middle_name": "COLLETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-19",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ND",
"license": "6470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.