Provider Demographics
NPI:1164655338
Name:HENDERSON, ANN BURNHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BURNHAM
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EAGLE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:RAPHINE
Mailing Address - State:VA
Mailing Address - Zip Code:24472-2612
Mailing Address - Country:US
Mailing Address - Phone:540-230-8397
Mailing Address - Fax:
Practice Address - Street 1:1 HEALTH CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2448
Practice Address - Country:US
Practice Address - Phone:540-458-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021488L29Medicare PIN