Individual
KRISTI A HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 936-6001
(601) 936-4389
Mailing address
PO BOX 16076, JACKSON, MS 39236-6076
(601) 936-6001
(601) 936-4389
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R850357
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118929
—
MS
01
—
512I500551
MEDICARE PTAN EFFECTIVE 7/2/08
MS
Enumeration date
08/23/2006
Last updated
06/14/2012
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