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NPI Code Detail

MEDICARE: CHERYL HENSON PA

MEDICARE: CHERYL HENSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-06674NC
2363AM0700XMedical Physician Assistant0010-06674NC
3363AS0400XSurgical Physician Assistant0010-06674NC
4363A00000XPhysician Assistant4691SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528057171
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL HENSON PA
Provider Business Mailing Address
First Line : PO BOX 602811
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2811
Country : US
Telephone Number : 828-213-1500
Fax Number : 828-651-6570
Provider Business Practice Location Address
First Line : 1621 HIGHWAY 17 N
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-2229
Country : US
Telephone Number : 843-353-3460
Fax Number : 843-353-3461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 05/24/2023

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