Provider Demographics
NPI:1114311834
Name:HENDERSON, RACHAEL MAE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:MAE
Last Name:HENDERSON
Suffix:
Gender:
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PIEDMONT GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-8534
Mailing Address - Country:US
Mailing Address - Phone:864-266-8498
Mailing Address - Fax:
Practice Address - Street 1:37 VILLA RD STE 508
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3040
Practice Address - Country:US
Practice Address - Phone:864-973-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19364363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily