Provider Demographics
NPI:1992232631
Name:HENDERSON, LINDSAY BETH (MD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1981
Mailing Address - Country:US
Mailing Address - Phone:785-342-4603
Mailing Address - Fax:
Practice Address - Street 1:9 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-2135
Practice Address - Country:US
Practice Address - Phone:660-386-7008
Practice Address - Fax:660-386-7009
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017013452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO210096942Medicaid