Provider Demographics
NPI:1639239288
Name:DEDMONDT, HENRIETTE MASON (RN,MSN,FNP)
Entity Type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:MASON
Last Name:DEDMONDT
Suffix:
Gender:F
Credentials:RN,MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:317 N KING ST STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4349
Practice Address - Country:US
Practice Address - Phone:828-693-3344
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3157363LF0000X
NC5013979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3357143OtherUHC
NC1639239288Medicaid
NC20EMMOtherBCBS NC
NCQ00028729OtherRAILROAD MEDICARE
NC9284962OtherCIGNA
NCNNF092AOtherMEDICARE