Individual
MRS. TIA LYANN HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 331-6431
Mailing address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 331-6431
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2022026226
MO
Other
Enumeration date
08/25/2022
Last updated
12/29/2024
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