Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Miyagi Henderson

Individual provider Family Nurse Practitioner · NPI 1588293518

Miyagi Henderson is a Nurse Practitioner in Slidell, Louisiana. Qualified in 2020, 6 years ago. Practices with E. M. Dimitri, DO Pmc, a 14-clinician group and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
6
Licensed in
LA
In the registry since
2020
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Practice location Address checks out

2104 Gause Blvd W Ste A
Slidell, LA 70460-4130
Phone: (504) 229-7454
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP215714 (LA)

Record details

NPI number1588293518
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedApril 2, 2020
Last updated in NPPESDecember 6, 2023
Certification dateDecember 6, 2023
Mailing addressPo Box 7020, Slidell, LA 70469-7020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice E. M. Dimitri, D.O. Pmc. — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Slidell