Provider Demographics
NPI:1275135428
Name:MCHENRY, TERRISSA BETHANNE
Entity Type:Individual
Prefix:
First Name:TERRISSA
Middle Name:BETHANNE
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WV HIGHWAY 5 E
Mailing Address - Street 2:
Mailing Address - City:SAND FORK
Mailing Address - State:WV
Mailing Address - Zip Code:26430-8159
Mailing Address - Country:US
Mailing Address - Phone:304-406-4890
Mailing Address - Fax:
Practice Address - Street 1:5530 WV HIGHWAY 5 E
Practice Address - Street 2:
Practice Address - City:SAND FORK
Practice Address - State:WV
Practice Address - Zip Code:26430-8159
Practice Address - Country:US
Practice Address - Phone:304-406-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant