Stephanie Terrell Henderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9474 Issued in GA

Practice address

313 Revolution Dr
Peachtree City, GA 30269-1086

Phone

(252) 342-5772

NPI assigned

Oct 4, 2021

Sex

Female

Sole proprietor

Yes

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": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1093487407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 REVOLUTION DR",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691086",
            "telephone_number": "252-342-5772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 REVOLUTION DR",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691086",
            "telephone_number": "252-342-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "STEPHANIE",
        "middle_name": "TERRELL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Hefter
• Krista Heim
• Donna Kay Heinlen, LPC
• Kristi Hellenbrand, D.C.
• John L Henahan, OD
• Christopher L Hendley, DPT
• Genevieve Daniel Hernandez, LPC
• Matthew Emerson Herrick, DPT
• Joni Christina Herron, LPC
• Katherine Hester, BS, LAT, ATC

• Physician Assistant in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; 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.