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NPI Code Detail

MEDICARE: ASHLEY HENEGAR

MEDICARE:   ASHLEY  HENEGAR
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
1363AM0700XMedical Physician Assistant01666WV

General Provider Information

NPI Number : 1659623817
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY HENEGAR
Provider Business Mailing Address
First Line : 301 COVE ST
Second Line :
City : BLUEFIELD
State : VA
Zip : 24605-9667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1027 FREDERICK ST
Second Line :
City : BLUEFIELD
State : WV
Zip : 24701-3942
Country : US
Telephone Number : 304-325-8104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2012
Last Update Date : 10/11/2012

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Directions to “ ASHLEY HENEGAR ” Practice Location

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