Provider Demographics
NPI:1255859435
Name:HENDERSHOTT, ABBEY JO (CNP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:JO
Last Name:HENDERSHOTT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:JO
Other - Last Name:CHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5335 FAR HILLS AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2317
Mailing Address - Country:US
Mailing Address - Phone:937-433-8212
Mailing Address - Fax:937-433-8246
Practice Address - Street 1:5335 FAR HILLS AVE STE 112
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2317
Practice Address - Country:US
Practice Address - Phone:937-433-8212
Practice Address - Fax:937-433-8246
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.021649OtherCERTIFIED NURSE PRACTITIONER
OHRN.367050OtherREGISTERED NURSE