Healthcare Provider Details

I. General information

NPI: 1790118289
Provider Name (Legal Business Name): MARK A HERNDON CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 HENDERSONVILLE RD
FLETCHER NC
28732-8241
US

IV. Provider business mailing address

3845 HENDERSONVILLE RD
FLETCHER NC
28732-8241
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-1644
  • Fax: 828-684-0648
Mailing address:
  • Phone: 828-684-1644
  • Fax: 828-684-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: