Provider Demographics
NPI:1992724967
Name:HENDERSON, COURTNEY MOORE (MS, RNC, WHNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MOORE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 HARDINGS TRACE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7000
Mailing Address - Country:US
Mailing Address - Phone:804-360-9596
Mailing Address - Fax:804-213-0548
Practice Address - Street 1:201 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2601
Practice Address - Country:US
Practice Address - Phone:804-254-1760
Practice Address - Fax:804-213-0548
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001-157456363LW0102X
VA0024157456363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health