MR. EDWARD MACK HENDRICKS (NPI# 1407190309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407190309 |
| Entity Type | Individual |
| Full Name | MR. EDWARD MACK HENDRICKS |
| Credential | FNP-BC |
| Practice Address |
1181 Paddock Rd Smyrna DE 19977-9679 |
| Practice Telephone | 3026539261 |
| Practice Fax Number | 3026596887 |
| Mailing Telephone | 3026539261 |
| Mailing Fax Number | 3026596887 |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
R159470 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
LG-0000616 | DE | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427449354 | Edward Scott Hendricks | Optometrist | 1737 First St, Napa, CA 94559 | 2015-02-13 |
| 1104088863 | Edward Cale Hendricks | Anesthesiology | 7519 Hospital Dr, Gloucester, VA 23061-4178 | 2008-06-25 |
| Street Address |
1181 PADDOCK RD |
| City | SMYRNA |
| State | DE |
| Zip Code | 19977-9679 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831353515 | Louise Desrosiers | General Practice | 1181 Paddock Rd, Smyrna, DE 19977-9679 | 2008-07-11 |
| 1083251243 | Jordan Cunningham | Physician Assistant | 1181 Paddock Rd, Smyrna, DE 19977-9679 | 2019-12-06 |
| 1497252266 | Flora Atangcho | Nurse Practitioner | 1181 Paddock Rd, Smyrna, DE 19977-9679 | 2018-04-09 |
| 1215481411 | Kathleen Gustafson | Nurse Practitioner | 1181 Paddock Rd, Smyrna, DE 19977-9679 | 2016-08-05 |
| 1336508027 | Paola Andrea Munoz | Psychologist | 1181 Paddock Rd, Jtvcc - Connections Community Support Programs, Smyrna, DE 19977-9679 | 2016-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477195857 | Nicola Dwyer | Licensed Practical Nurse | 121 Balamor Ct, Smyrna, DE 19977 | 2019-10-17 |
| 1487202982 | Steps 2 Wellness, LLC | Nurse Practitioner | 229 N Main Street, Smyrna, DE 19977 | 2019-08-28 |
| 1609423813 | Nu Beginning Center, LLC | Community/Behavioral Health | 229 North Main Street, Smyrna, DE 19977 | 2019-08-22 |
| 1467959593 | Cimi Behavior Analytic Solutions | Behavioral Analyst | 329 Garrisons Lake Blvd, Smyrna, DE 19977 | 2018-04-05 |
| 1548795859 | Connections Community Support Programs, Inc. | Clinic/Center | 350 N. High Street Extension, Smyrna, DE 19977 | 2017-04-24 |
| 1912352782 | Elizabeth Soleh Kerkula | Registered Nurse | 611 Providence Drive, Smyrna, DE 19977 | 2016-04-29 |
| 1780075218 | Life Force Caregivers, Inc. | Custodial Care Facility | 127 E. Glenwood Ave., Smyrna, DE 19977 | 2015-02-05 |
| 1164826707 | Naomi Ruth Thomas | Registered Nurse | 654 Brenford Station Road, Smyrna, DE 19977 | 2014-10-10 |
| 1104164524 | Christianacare Health Systems | Clinic/Center | 100 Sunnyside Rd 3rd Floor Prickett South, Smyrna, DE 19977 | 2013-01-18 |
| 1891056529 | Alex Bongon Siapno | Physical Therapist | 3034 S Dupont Blvd., Smyrna, DE 19977 | 2012-05-29 |
| Find all providers in zip 19977 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487260972 | Olivia Sims Michel | Nurse Practitioner | 3375 Spring Hill Pkwy Se Apt 1729, Smyrna, GA 30080-6867 | 2020-09-20 |
| 1881205169 | Suny Varughese | Nurse Practitioner | Minute Clinic, 2994 Atlanta Rd, Se, Smyrna, GA 30080 | 2020-08-11 |
| 1336606060 | Eunice Carreen Boyd-gant | Nurse Practitioner | 249 Arrowood Dr, Smyrna, DE 19977-4443 | 2019-02-28 |
| 1801351564 | Nicole Howard | Nurse Practitioner | 100 S Main St Ste 205, Smyrna, DE 19977-1479 | 2019-02-07 |
| 1104390491 | Lydia Al-awabdy | Nurse Practitioner | 501 Tackett Farms Rd, Smyrna, GA 30082-3918 | 2019-01-19 |
| 1346714094 | Angelica Marie Epps | Nurse Practitioner | 1505 Countryside Pl Se, Smyrna, GA 30080-8247 | 2019-01-16 |
| 1871085530 | Jessica Rose Goergen | Nurse Practitioner | 4441 Atlanta Rd Se Ste 317, Smyrna, GA 30080-6443 | 2018-05-30 |
| 1063965168 | Tehri Kellie Roberts | Nurse Practitioner | 300 Stonecrest Blvd Ste 210, Smyrna, TN 37167-6800 | 2016-07-26 |
| 1164885935 | Jullie Sweetser | Nurse Practitioner | 4452 Oakdale Rd Se, Smyrna, GA 30080-6934 | 2016-03-30 |
| 1790167856 | Kay Yetunde Johnson | Nurse Practitioner | 3001 Lusk Dr, Smyrna, GA 30080 | 2015-06-25 |
| Find all providers in SMYRNA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.