Provider Demographics
NPI:1215693379
Name:HENEMYER, SANDRA KAY (FNP-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:HENEMYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:HENEMYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 HILLGROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4806
Mailing Address - Country:US
Mailing Address - Phone:520-955-0199
Mailing Address - Fax:
Practice Address - Street 1:291 N PECOS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1918
Practice Address - Country:US
Practice Address - Phone:702-616-9471
Practice Address - Fax:702-616-9681
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily