Provider Demographics
NPI:1316452253
Name:HENDERSON, BRANDY DAVINA (RN,FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:DAVINA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN,FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9775 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1442
Mailing Address - Country:US
Mailing Address - Phone:513-853-9700
Mailing Address - Fax:513-852-8971
Practice Address - Street 1:4950 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3840
Practice Address - Country:US
Practice Address - Phone:937-496-2020
Practice Address - Fax:937-496-2016
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP277614163WG0000X
OHAPRN.CNP.026361363LP0808X
OHCNP.026361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily