Individual
MARISSA LYNNE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1055 HOWELL MILL RD NW, ATLANTA, GA 30318-5557
(866) 849-0692
Mailing address
PO BOX 211699, EAGAN, MN 55121-3699
(866) 849-0692
(888) 973-8821
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10041652
OR
363L00000X
Nurse Practitioner
2025008125
MO
363L00000X
Nurse Practitioner
232324
AR
363L00000X
Nurse Practitioner
3-002294
AL
363L00000X
Nurse Practitioner
30139
SC
363L00000X
Nurse Practitioner
322525
AZ
363L00000X
Nurse Practitioner
38496
TN
363L00000X
Nurse Practitioner
4035650
KY
363L00000X
Nurse Practitioner
907312
MS
363L00000X
Nurse Practitioner
Primary
AP143723
TX
363L00000X
Nurse Practitioner
AP61670672
WA
363L00000X
Nurse Practitioner
APRN11037949
FL
363L00000X
Nurse Practitioner
C-APN.0103933-C-NP
CO
363L00000X
Nurse Practitioner
GAA-NP003247
GA
363L00000X
Nurse Practitioner
SP032352
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBS
TX
05
—
PENDING
—
TX
Enumeration date
11/14/2019
Last updated
09/22/2025
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