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Individual

JAMIE LYNN HENDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
707 N MICHIGAN ST STE 400, SOUTH BEND, IN 46601-1071
(574) 647-8470
(574) 647-8475
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28215294A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300084195
IN
Enumeration date
10/05/2023
Last updated
01/08/2024
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