Healthcare Provider Details

I. General information

NPI: 1255114880
Provider Name (Legal Business Name): PAMELA HENSHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3266 INTERNATIONAL DR
MOBILE AL
36606-3005
US

IV. Provider business mailing address

7864 HEATON DR E
THEODORE AL
36582-2358
US

V. Phone/Fax

Practice location:
  • Phone: 251-635-9881
  • Fax:
Mailing address:
  • Phone: 251-635-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number81052
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: