Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 04-44655 | KS |
N | 111NI0900X | Internist | 04-44655 | KS |
Y | 207R00000X | Internist | 39361 | TN |
Y | 111NI0900X | Internist | 39361 | TN |
N | 207R00000X | Internist | MD-46979 | IA |
N | 111NI0900X | Internist | MD-46979 | IA |
N | 207R00000X | Internist | ME145469 | FL |
N | 111NI0900X | Internist | ME145469 | FL |
N | 207R00000X | Internist | S7231 | TX |
N | 111NI0900X | Internist | S7231 | TX |
N | 207RG0300X | Geriatric Medicine | 39361 | TN |
N | 207RH0002X | Hospice and Palliative Medicine | 39361 | TN |
NPI | 1013966423 |
---|---|
Provider Name | Dr. Melinda Shaw Henderson |
First Address | Brentwood, TN 37027-7410 |
Second Address | Nashville, TN 37206-3614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 18/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131691 | (05) | IA |
0425399 | (05) | OH |
109478800 | (05) | FL |
201357160A | (05) | KS |
3327126 | (05) | TN |
39361 | MEDICAL LICENSE (01) | TN |
422491701 | (05) | TX |
64095060 | (05) | KY |