Lateasha Lakira Henderson, FNP
Individual provider Active NPI Family Nurse Practitioner · Greenville, SC
NPI 1730799800 · NPPES record last updated Sep 13, 2021
Key facts
- NPI
- 1730799800
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 24224 (SC)
- Practice address
- 3901 Pelham Rd
Greenville, SC 29615-5004 - Phone
- (864) 288-3672
- NPI assigned
- Aug 4, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210427000175 | SC | Practitioner - Nurse Practitioner | 4486062759 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24224 | SC | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Che Behavioral Health Services of South Carolina, P.C. | Current |
Accepting new patients |
Locations
220 N Main St
Ste 500
Greenville, SC 29601
Phone (347) 294-3414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 24224 | SC | Yes |
Addresses
Primary practice location
3901 Pelham Rd
Greenville, SC 29615-5004
Mailing address
3901 Pelham Rd
Greenville, SC 29615-5004
Phone (864) 288-3672
Other providers in Greenville, SC
- Ella Walker Henderson
- Hailey Henderson
- Joseph Houston Henderson
- Kim Denise Henderson
- Lakeisha Shunte Henderson
- Lora Carol Henderson
- Michelle Sproat Henderson
- Nancy Ann Henderson
- Rachael Mae Henderson
- Rebecca Henderson
All providers in Greenville, SC · Family Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.