Provider Demographics
NPI:1013982917
Name:HENDRIX, ANNE MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3745
Mailing Address - Country:US
Mailing Address - Phone:803-782-4051
Mailing Address - Fax:
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8008
Practice Address - Country:US
Practice Address - Phone:803-434-3800
Practice Address - Fax:803-376-5885
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102568363A00000X
SC2263363LF0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2652PAMedicaid
NCP05562Medicare UPIN