MEDICARE: VALENCIA JOYCE HENRY DNP

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	363L00000X	Nurse Practitioner	005324	CT
2	363LF0000X	Family Nurse Practitioner	005324	CT
3	363LF0000X	Family Nurse Practitioner	R203517	MD
4	363LP2300X	Primary Care Nurse Practitioner	22494	SC
5	363LP2300X	Primary Care Nurse Practitioner	5010395	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

General Provider Information

NPI Number	:	1679816870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENCIA JOYCE HENRY DNP

Provider Business Mailing Address
First Line	:	4016 RIVER OAKS DR STE 6
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6674
Country	:	US
Telephone Number	:	860-951-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 N OAK ST STE 2
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3580
Country	:	US
Telephone Number	:	843-507-2777
Fax Number	:

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	03/01/2022

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