Healthcare Provider Details

I. General information

NPI: 1023055811
Provider Name (Legal Business Name): KERRY HENDRIX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3263 PROFFIT RD SUITE 101
CHARLOTTESVILLE VA
22911-5639
US

IV. Provider business mailing address

PO BOX 75268
BALTIMORE MD
21275-5268
US

V. Phone/Fax

Practice location:
  • Phone: 434-923-4600
  • Fax: 434-975-1384
Mailing address:
  • Phone: 434-982-7794
  • Fax: 434-982-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024103973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: