Provider Demographics
NPI:1417940164
Name:HENIGHAN, RICHARD PETER (APRN, BC, FNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PETER
Last Name:HENIGHAN
Suffix:
Gender:M
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CEDAR ST.
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-4846
Mailing Address - Country:US
Mailing Address - Phone:865-453-1032
Mailing Address - Fax:865-453-7271
Practice Address - Street 1:227 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37864-4648
Practice Address - Country:US
Practice Address - Phone:865-453-1032
Practice Address - Fax:865-453-7271
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000044222163WP2201X
TNAPN0000005392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS91984Medicare UPIN
TN3904578Medicare ID - Type UnspecifiedPROVIDER NUMBER