Kellie Lawrence Henderson, PA is a medicare enrolled "Physician Assistant - Medical" in East Ridge, Tennessee. Her current practice location is
1508 Tombras Ave, East Ridge, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(423) 867-4969.
Kellie Lawrence Henderson is licensed to practice in Tennessee (license number PA0000001098) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1225145865.
Provider's Profile
| Full Name | Kellie Lawrence Henderson |
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| Gender | Female |
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| Speciality | Physician Assistant - Medical |
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| Location | 1508 Tombras Ave, East Ridge, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1225145865
- Provider Enumeration Date: 08/23/2006
- Last Update Date: 08/05/2015
Medicare PECOS Information:
- PECOS PAC ID: 3375431786
- Enrollment ID: I20040308000916
Medical Identifiers
Medical identifiers for Kellie Lawrence Henderson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1225145865 | NPI | - | NPPES |
| 4219886 | Other | TN | BCBS- TENNESSEE |
| Q007546 | Medicaid | TN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363AM0700X | Physician Assistant - Medical | PA0000001098 (Tennessee) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kellie Lawrence Henderson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kellie Lawrence Henderson, PA
1508 Tombras Ave,
East Ridge, TN 37412-2720
Ph: (423) 867-4969 | Kellie Lawrence Henderson, PA
1508 Tombras Ave,
East Ridge, TN 37412-2720
Ph: (423) 867-4969 |
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