Provider Demographics
NPI:1215325105
Name:HENDERSON, SHELLEY ELAINE (MSN, RN, APRN)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ELAINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN, RN, APRN
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ELAINE
Other - Last Name:MENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8193 MALL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:859-525-0173
Practice Address - Street 1:8193 MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:859-525-0173
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17912-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily