Provider Demographics
NPI:1043699473
Name:HENDERSON, CARRIE SKINNER (FNP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:SKINNER
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:AILLEN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:34 CLUB FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3152
Mailing Address - Country:US
Mailing Address - Phone:864-498-8208
Mailing Address - Fax:
Practice Address - Street 1:2210 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3224
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3236Medicaid
SCSC6067Medicare PIN