Colleen Henderson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2015021650 Issued in IN

Practice address

303 N 7TH St
Kentland, IN 47951-1379

Phone

(219) 474-5464

NPI assigned

Jan 26, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1992162648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N 7TH ST",
            "city": "KENTLAND",
            "state": "IN",
            "postal_code": "479511379",
            "telephone_number": "219-474-5464",
            "fax_number": "219-474-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N 7TH ST",
            "city": "KENTLAND",
            "state": "IN",
            "postal_code": "479511379",
            "telephone_number": "219-474-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "COLLEEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-26",
        "last_updated": "2020-10-13",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "2015021650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "colleen.henderson.1@15486.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "use this address for all",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "303 N 7th St",
            "city": "Kentland",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479511379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Iroquois Memorial Hospital and Resident Home (IMH Kentland Clinic)
• Kentland Family Dentistry
• Lowell G. Mitchell Jr.
• Michelle Stoyanov Moore, PA-C

• Family Nurse Practitioner in Kentland, IN
• Providers in Kentland, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.