Provider Demographics
NPI:1942230396
Name:HENDERSON, FELICIA J (AAS)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 OLD SPEARS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5158
Mailing Address - Country:US
Mailing Address - Phone:910-425-7926
Mailing Address - Fax:910-425-8064
Practice Address - Street 1:1817 MURCHISON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4060
Practice Address - Country:US
Practice Address - Phone:910-425-7926
Practice Address - Fax:910-425-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060394251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health