Active NPI
Dalton T Henderson, APRN
- Family Nurse Practitioner
- Paducah, KY
National Provider Identifier
1841914439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 39140
- Practice address
- 2005 Broadway St
Paducah, KY 42001-7107 - Phone
- (270) 366-7650
- Fax
- (270) 443-0660
- NPI assigned
- Sep 28, 2022
- Last updated
- Sep 28, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 39140 | KY | Primary |
Addresses
Primary practice location
2005 Broadway St
Paducah, KY 42001-7107
Mailing address
2005 Broadway St
Paducah, KY 42001-7107
Phone (270) 366-7650
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | AthenaHealth.com | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2026
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2005 Broadway St
Paducah, KY 42001-7107
Phone (270) 366-7650
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39140 | KY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Internal Medicine PLLC | Family | Current | Accepting new patients |
| Southeastern Emergency Physicians LLC | Current | Accepting new patients |
Locations
1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521
2005 Broadway St
Paducah, KY 42001
Phone (270) 366-7650
2501 Kentucky Ave
Paducah, KY 42003
Phone (270) 575-2180
Interoperability endpoints
- dalton.henderson.1@9112.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Maysville, KY
- NPI 1356379382
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Baptist Health Home Care
- Home Health Agency
- Paducah, KY
- NPI 1780498030
-
- General Acute Care Hospital
- Paducah, KY
- NPI 1730264128
-
- Critical Access Hospital
- Benton, KY
- NPI 1568528594
-
- General Acute Care Hospital
- Paducah, KY
- NPI 1346244126
-
- Critical Access Hospital
- Metropolis, IL
- NPI 1790788578
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1841914439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 BROADWAY ST",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420017107",
"telephone_number": "270-366-7650",
"fax_number": "270-443-0660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 BROADWAY ST",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420017107",
"telephone_number": "270-366-7650",
"fax_number": "270-443-0660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "DALTON",
"middle_name": "T",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-28",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "KY",
"license": "39140",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "AthenaHealth.com",
"affiliation": "N",
"endpointDescription": "Cloud Based EMR system",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Transfer of Patient Health Information",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2005 Broadway St",
"city": "Paducah",
"state": "KY",
"country_code": "US",
"postal_code": "420017107",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.