MEDICARE: BYEOL AH HENSON

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	363A00000X	Physician Assistant	0010-10500	NC

General Provider Information

NPI Number	:	1164087094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYEOL AH HENSON

Provider Business Mailing Address
First Line	:	207 REEDHAVEN DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-2763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 W ARLINGTON BLVD STE C
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5783
Country	:	US
Telephone Number	:	252-317-1195
Fax Number	:	252-317-1111

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	08/24/2020

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