Basic Information
| Provider Information | |||||||||
| NPI: | 1962534107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | MARTHA KAYE | ||||||||
| MiddleName: | LLOYD | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2347 SIMONTON RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286258246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048734719 | ||||||||
| FaxNumber: | 7048721810 | ||||||||
| Practice Location | |||||||||
| Address1: | 2347 SIMONTON RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286258246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048734719 | ||||||||
| FaxNumber: | 7048721810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.