Healthcare Provider Details

I. General information

NPI: 1669272795
Provider Name (Legal Business Name): HENDERSHOT WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E MARKET ST
CLEARFIELD PA
16830-2424
US

IV. Provider business mailing address

235 E MARKET ST
CLEARFIELD PA
16830-2424
US

V. Phone/Fax

Practice location:
  • Phone: 814-577-5875
  • Fax:
Mailing address:
  • Phone: 814-205-4957
  • Fax: 814-205-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY WARRICK
Title or Position: OWNER
Credential: CRNP
Phone: 814-205-4957