Provider Demographics
NPI:1184438616
Name:HENEGAR, JEREMEY
Entity type:Individual
Prefix:
First Name:JEREMEY
Middle Name:
Last Name:HENEGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 ROBERT C BYRD DR STE 360
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4467
Mailing Address - Country:US
Mailing Address - Phone:304-894-4332
Mailing Address - Fax:
Practice Address - Street 1:3049 ROBERT C BYRD DR STE 360
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4467
Practice Address - Country:US
Practice Address - Phone:304-894-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-9176175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist