Kelley Henderson, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL1031 Issued in FL

Practice address

11000 University Parkway
Pensacola, FL 32514

Phone

(817) 257-5573

Fax

(817) 257-7702

NPI assigned

Mar 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1952425514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 UNIVERSITY PARKWAY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32514",
            "telephone_number": "850-291-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 UNIVERSITY PARKWAY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32514",
            "telephone_number": "817-257-5573",
            "fax_number": "817-257-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KELLEY",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT3804",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL1031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hematology Oncology Associates PA (Hope Medical Group)
• Ruth A Henchey, MD
• Ashley Henderson, DPT
• Christopher Henderson III, PHARMACIST
• Colin Reed Henderson, DO
• Tania Henderson, M. S., BCBA
• Tristin B Henderson
• Kimberley Lynn Hendricks, APRN, ACCNS-P
• Dawn M Hendrickson, OT
• Isabella Marie Hendrickson, MD

• Athletic Trainer in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; 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.