Individual
CARON GIBSON HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1616 WILLIAMS DR, LEAKESVILLE, MS 39451-5622
(601) 394-2381
(601) 394-5715
Mailing address
PO BOX 160, LEAKESVILLE, MS 39451-0160
(601) 394-2381
(601) 394-5715
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R873868
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09228250
—
MS
Enumeration date
08/31/2010
Last updated
03/29/2014
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