Provider Demographics
NPI:1265961213
Name:HENDERSON, ERIKA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:NICOLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:N
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:33820 OLD VALLEY PIKE STE 2
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-3793
Practice Address - Country:US
Practice Address - Phone:540-459-1310
Practice Address - Fax:540-459-1311
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2066363A00000X
363A00000X
VA0110006538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant