Provider Demographics
NPI:1720420474
Name:HENDERSON, MICHELLE SPROAT (FNP, DNP, JD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SPROAT
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP, DNP, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INDEPENDENCE PT STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4558
Mailing Address - Country:US
Mailing Address - Phone:855-523-9355
Mailing Address - Fax:
Practice Address - Street 1:2 INDEPENDENCE PT STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4558
Practice Address - Country:US
Practice Address - Phone:855-523-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178796363L00000X
COC-APN.0001856-C-NP363L00000X
TXAP146067363L00000X
WV61062324363L00000X
NV827986363L00000X
WA61062324363L00000X
FLAPRN11008513363L00000X
SC18375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner