Provider Demographics
NPI:1043640030
Name:HENRY, MELISSA FOX (CRNA, DNAP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FOX
Last Name:HENRY
Suffix:
Gender:F
Credentials:CRNA, DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PONSBURY RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2690
Mailing Address - Country:US
Mailing Address - Phone:703-863-8208
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:DEPARTMENT OF NURSE ANESTHESIA
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-2322
Practice Address - Fax:843-792-9314
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered