Charisse Dupree-Henegan, REGISTER NURSE

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

203456 Issued in SC

Practice address

210 Pegonia LN
Blythewood, SC 29016-7234

Phone

(803) 605-4161

NPI assigned

Jul 13, 2021

Last updated

Jul 13, 2021By 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": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1457923013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 PEGONIA LN",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290167234",
            "telephone_number": "803-605-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PEGONIA LN",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290167234",
            "telephone_number": "803-605-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPREE-HENEGAN",
        "first_name": "CHARISSE",
        "name_prefix": "Mrs.",
        "credential": "REGISTER NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "SC",
            "license": "203456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Sara Beaver, LLC (Blythewood Eye Care)
• Drayer Physical Therapy - South Carolina, LLC
• Shepherd Lee Drayton III, MD
• Jessie Driggers
• Lakeisha Dunson
• Ellison Sloan Eargle, PTA
• Carlton Edwards III, PHARMD
• Shontrelle Edwards
• Keandria R Elliott, DPT
• Engage Pediatric Therapy

• General Practice Registered Nurse in Blythewood, SC
• Providers in Blythewood, SC by specialty
• General Practice Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.