Basic Information
| Provider Information | |||||||||
| NPI: | 1245249051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2902 SW ASBURY DR | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666144466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852700197 | ||||||||
| FaxNumber: | 7853680474 | ||||||||
| Practice Location | |||||||||
| Address1: | 2902 SW ASBURY DR | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666144466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852700197 | ||||||||
| FaxNumber: | 7853680474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 05-26614 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100312040A | 05 | KS | MEDICAID | 067175 | 01 | KS | MEDICARE PTAN | OTHER |