JACOB RAY HENDERSON DO NPI 1487232401

NPI Information

  • NPI: 1487232401
  • Provider Name: JACOB RAY HENDERSON, DO
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4500 SAN PABLO RD S
    JACKSONVILLE, FL
    ZIP 32224
  • Phone: (904) 953-2000

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NPI Details

Jacob Ray Henderson, DO is a nephrology internal medicine in Jacksonville, FL with 4 years of experience. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. Jacob Ray Henderson, DO NPI is 1487232401. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF PIKEVILLE, KENTUCKY COLLEGE OF OSTEOPATHIC MED
Graduation Year:2021

The provider's business location address is:

4500 SAN PABLO RD S
JACKSONVILLE, FL
ZIP 32224-865
Phone: (904) 953-2000

The NPI 1487232401 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/31/2021 and was last updated on 10/21/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RN0300XInternal MedicineNephrologyOS21003FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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