MEDICARE: MRS. RACHAEL MAE HENDERSON FNP-C, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	19364	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	19364	SC

General Provider Information

NPI Number	:	1114311834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHAEL MAE HENDERSON FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	405 PIEDMONT GOLF COURSE RD
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-8534
Country	:	US
Telephone Number	:	864-266-8498
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 VILLA RD STE 508
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3040
Country	:	US
Telephone Number	:	864-973-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	04/16/2025

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