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  7. NPI Record 1720512254

MISS KEYANA NICOLE HENDERSON 172V00000X
Complete NPI Record 1720512254
Community Health Worker in San Francisco, CA

NPI Status: Active since April 11, 2017

Contact Information

1801 VICENTE ST
SAN FRANCISCO, CA
ZIP 94116
Phone: (415) 681-3211
Fax: (415) 664-7094

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Other Provider Identifier 1
  28. Other Provider Identifier Type Code 1
  29. Other Provider Identifier State 1
  30. Other Provider Identifier Issuer 1
  31. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1720512254. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1720512254
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: KEYANA
The first name of the provider, if the provider is an individual.
Provider Middle Name: NICOLE
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: MISS
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: 172V00000X
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 1801 VICENTE ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: SAN FRANCISCO
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address State Name: CA
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address Postal Code: 941162923
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address Telephone Number: 4156813211
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Fax Number: 4156647094
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider First Line Business Practice Location Address: 1801 VICENTE ST
The city name in the mailing address of the provider being identified.
Provider Business Practice Location Address City Name: SAN FRANCISCO
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Practice Location Address State Name: CA
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address Postal Code: 941162923
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address Country Code If outside U S : US
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Practice Location Address Telephone Number: 4156813211
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Practice Location Address Fax Number: 4156647094
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Enumeration Date: 4/11/2017
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Last Update Date: 4/11/2017
The city name in the location address of the provider being identified.
Provider Gender Code: F
The State code in the location of the provider being identified.
Healthcare Provider Taxonomy Code 1: 172V00000X
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Healthcare Provider Primary Taxonomy Switch 1: Y
The country code in the location address of the provider being identified.
Other Provider Identifier 1: 172V00000X
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: CA
Other Provider Identifier Issuer 1: OTHER
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No