Provider Demographics
NPI:1689094997
Name:HEZEKIAH, ANISHA SHERRIE (NP)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:SHERRIE
Last Name:HEZEKIAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:147 SPINDLE WAY
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3635
Mailing Address - Country:US
Mailing Address - Phone:843-697-5282
Mailing Address - Fax:
Practice Address - Street 1:2998 W MONTAGUE AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5931
Practice Address - Country:US
Practice Address - Phone:843-501-2031
Practice Address - Fax:888-453-0810
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner