Deidra Henderson, R.N.
Individual provider Active NPI Registered Nurse · Apache, OK
NPI 1891159927 · NPPES record last updated Apr 5, 2016
Key facts
- NPI
- 1891159927
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R0074963 (OK)
- Practice address
- 48025 County Street 2580
Apache, OK 73006-9708 - Phone
- (580) 450-3257
- Fax
- (580) 588-2289
- NPI assigned
- Apr 5, 2016
- Sex
- Female
- 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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0074963 | OK | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R0074963 | OK | Yes |
Addresses
Primary practice location
48025 County Street 2580
Apache, OK 73006-9708
Mailing address
PO Box 224
Apache, OK 73006-0224
Phone (580) 450-3257
Other providers in Apache, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2016. 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.