Provider Demographics
NPI:1023055811
Name:HENDRIX, KERRY (NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75268
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5268
Mailing Address - Country:US
Mailing Address - Phone:434-982-7794
Mailing Address - Fax:434-982-7752
Practice Address - Street 1:3263 PROFFIT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-5639
Practice Address - Country:US
Practice Address - Phone:434-923-4600
Practice Address - Fax:434-975-1384
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024103973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020216M54Medicare PIN