Angela H Henson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085003341 Issued in IL

Practice address

310 West St. Louis Street
West Frankfort, IL 62896

Phone

(618) 993-0404

Fax

(618) 993-1717

NPI assigned

Oct 17, 2008

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

Other names 1

• Angela H Black Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: angela.henson.1@11869.direct.athenahealth.com

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.

• Pediatric Group LLC

  • Rural Health Clinic/Center
  • Marion, IL
  • NPI 1114129970
  NPD (past)

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1497907737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DRIVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "62959",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 WEST ST. LOUIS STREET",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "62896",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSON",
        "first_name": "ANGELA",
        "middle_name": "H",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "BLACK",
            "middle_name": "H",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hear 4 U Inc
• Heartland Radiology Associates LTD
• Heartland Women'S Healthcare LTD
• Rebecca Henry
• Kimberly Hensley
• Kendra Henson
• Sara Herr
• Herron Rehab and Wellness Center, S.C.
• Cheryl A Herron, D.C.
• Kent A Herron, DC

• Physician Assistant in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.