Active NPI
Sherry Henning
- Nurse Practitioner
- Clemmons, NC
National Provider Identifier
1720502040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5009779
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 5009779 | NC | MD | Nurse Practitioner |
| 242054 | SC | MD | Nurse 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.