Provider Demographics
NPI:1861097651
Name:HENEGAR, AMBER BRIANA (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BRIANA
Last Name:HENEGAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:BRIANA
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:124 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TN
Mailing Address - Zip Code:37694-3147
Mailing Address - Country:US
Mailing Address - Phone:423-707-4255
Mailing Address - Fax:
Practice Address - Street 1:124 HUGHES RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TN
Practice Address - Zip Code:37694-3147
Practice Address - Country:US
Practice Address - Phone:423-707-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000085347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPN0000085347OtherNURSING LICENSE