David B Henderson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

100436 Issued in NC

Practice address

1638 Owen Dr
Fayetteville, NC 28304-3424

Phone

(910) 609-4000

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cfvhs Ed Physicians

  • Emergency Medicine Physician
  • Fayetteville, NC
  • NPI 1215931589
  Medicare reassignment
• Cumberland County Hospital System Inc

  • Hematology & Oncology Physician
  • Fayetteville, NC
  • NPI 1881946242
  Medicare reassignment
• Cfvhs Ed Physicians

  • Emergency Medicine Physician
  • Raeford, NC
  • NPI 1790183184
  NPD
• Cumberland County Hospital System Inc

  • Clinical Cardiac Electrophysiology Physician
  • Fayetteville, NC
  • NPI 1831809755
  NPD
• Cumberland County Hospital System Inc

  • Hospitalist Physician
  • Dunn, NC
  • NPI 1124426804
  NPD (past)

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1184615239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "address_2": "ATTN: MANAGED CARE PLANNING",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949",
            "fax_number": "910-615-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DAVID",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NC",
            "license": "100436",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "100436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1184615239",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184615239",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA LICENSE",
            "identifier": "10436",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marla R. Hemphill, M.D.
• Lisa Renee Hemstreet, MS,HSP-PA
• Essence Henagan
• Nancy Henderson-Hines, M.D.
• Angela E Henderson, BS, CPSS
• Dionia R Henderson, OTR/L
• Essence Henderson
• Felicia J Henderson, AAS
• Joseph Bernard Henderson, D.O.
• Juderius Henderson, LCAS, LCSW-A

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.