MR. CORY RYAN HENDERSON PA-C
NPI 1174883292
Physician Assistant - Medical in Mcconnell Afb, KS

Q: What is Cory Henderson's NPI number?

The NPI number for Cory Henderson is 1174883292. It was assigned to this individual provider in the NPPES registry on May 23, 2012.

Q: What is Cory Henderson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Cory Henderson was last updated on August 15, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 23, 2012PECOS Enrolled

57950 LEAVENWORTH ST, MCCONNELL AFB, KS 67221(316) 759-5120(316) 759-6553 Get Directions Write a Review

NPPES record last updated: August 15, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 15, 2022, Dec 2, 2020 (2 updates tracked since 2020).

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About Mr. Cory Ryan Henderson Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CORY RYAN HENDERSON PA-C (NPI 1174883292) is an individual medical provider in Mcconnell Afb, Kansas and active in the NPI registry since May 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174883292

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameMR. CORY RYAN HENDERSONCredential: PA-C

Location Address57950 LEAVENWORTH STMcconnell Afb, KS 67221-3505

Mailing Address57950 Leavenworth StMcconnell Afb, KS 67221-3505 · (316) 759-5120 · Fax (316) 759-6553

Phone(316) 759-5120

Fax(316) 759-6553

Sole ProprietorYes

Enumeration DateMay 23, 2012

Last NPPES UpdateAugust 15, 20222 updates tracked since enumeration

NPPES CertifiedAugust 9, 2022

✔ NPI 1174883292 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

57950 LEAVENWORTH ST, Mcconnell Afb, KS 67221

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Cory Ryan Henderson Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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