MEDICARE: MS. DEBORAH A HENDRIX

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	5000026	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	562014989	OTHER	NC	TRICARE
3	00007	OTHER	NC	BC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609891001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH A HENDRIX

Provider Business Mailing Address
First Line	:	112 BAVARIAN DR
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-5100
Country	:	US
Telephone Number	:	910-602-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 BAVARIAN DR
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-5100
Country	:	US
Telephone Number	:	910-602-7775
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/04/2010

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