Individual
LAKEISHA SHUNTE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6119 WHITE HORSE RD STE 14, GREENVILLE, SC 29611-3838
(864) 614-7001
Mailing address
PO BOX 740013, ATLANTA, GA 30374-0013
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19844
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0915346
BOARD CERTIFICATION AANP
TX
05
—
NP3551
—
SC
Enumeration date
11/02/2015
Last updated
02/20/2024
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