Healthcare Provider Details

I. General information

NPI: 1164655338
Provider Name (Legal Business Name): ANN BURNHAM HENDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 01/31/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTH CIR
LEXINGTON VA
24450-2448
US

IV. Provider business mailing address

116 EAGLE VIEW LN
RAPHINE VA
24472-2612
US

V. Phone/Fax

Practice location:
  • Phone: 540-458-3300
  • Fax:
Mailing address:
  • Phone: 540-230-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003084
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: