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

Mrs. Lisa Renee Henderson, AGNP-C

Individual provider Nurse Practitioner · NPI 1912419243

Mrs. Lisa Renee Henderson, AGNP-C is a Nurse Practitioner in Lewiston, Idaho. Qualified in 2017, 9 years ago. Practices with Ppm Washington LLC, a 7-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
9
Licensed in
ID
In the registry since
2017
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Practice location Address checks out

415 Sixth St Cardiology Dept
Lewiston, ID 83501-4255
Phone: (208) 750-7507
Fax: (208) 750-7384
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 57109 (ID)

Record details

NPI number1912419243
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-C
Sole proprietorNo
NPI enumeratedOctober 26, 2017
Last updated in NPPESNovember 14, 2019

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Ppm Washington Llc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Lewiston