Dominique S Hendricks

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

40469 Issued in WV

Practice address

67 Casino Drive
Anmoore, WV 26323

Phone

(304) 622-1684

Fax

(304) 622-0810

NPI assigned

Sep 6, 2023

Last updated

Sep 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1083490031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 315",
            "city": "ANMOORE",
            "state": "WV",
            "postal_code": "263230315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 CASINO DRIVE",
            "city": "ANMOORE",
            "state": "WV",
            "postal_code": "26323",
            "telephone_number": "304-622-1684",
            "fax_number": "304-622-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "DOMINIQUE",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WV",
            "license": "40469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia L. Zwolensky, O.D., PLLC
• Doctors Quick Care
• For Your Eyes Only Optometrists, P.L.L.C.
• Desirae Noelle Greathouse, LPN
• Jemia Marie Gregory
• Adria Lafferty, RN
• Marianne Martin
• Luke K Rinehart, OTR/L
• Tender Loving Care Health Care Services of West Virginia, L.L.C. (Amedisys Home Health Care)
• Town of Anmoore (Anmoore EMS)

• Licensed Practical Nurse in Anmoore, WV
• Providers in Anmoore, WV by specialty
• Licensed Practical Nurse in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.