Individual provider Active NPI

Sherry Henning

  • Nurse Practitioner
  • Clemmons, NC
National Provider Identifier
1720502040
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5009779 Issued in NC
Practice address
7210 Village Medical Cir Ste 225
Clemmons, NC 27012-8035
Phone
(336) 893-3080
Fax
(336) 893-3089
NPI assigned
Jul 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 242054 SC
Nurse Practitioner 363L00000X 5009779 NC Primary

Addresses

Primary practice location

7210 Village Medical Cir Ste 225
Clemmons, NC 27012-8035

Mailing address

PO Box 75216
Charlotte, NC 28275-0216

Other practice location 1

2119 E South Blvd Ste 200
Montgomery, AL 36116-2496
Phone (334) 613-7070

Other practice location 2

140 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6185
Phone (336) 245-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5009779NCMDNurse Practitioner
242054SCMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1720502040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282750216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 VILLAGE MEDICAL CIR STE 225",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128035",
            "telephone_number": "336-893-3080",
            "fax_number": "336-893-3089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2119 E South Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361162496",
            "country_code": "US",
            "telephone_number": "334-613-7070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140 Kimel Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271036185",
            "country_code": "US",
            "telephone_number": "336-245-2100",
            "fax_number": "336-768-7782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNING",
        "first_name": "SHERRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-28",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "242054",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; 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.