Individual
MS. TAMIKIO KWAN HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
300 W HOSPITAL RD, EISENHOWER ARMY MEDICAL CENTER, FORT GORDON, GA 30905-5741
(706) 787-2720
Mailing address
5979 DESERT STORM AVE, FORT CAMPBELL, KY 42223-5514
(270) 412-1273
(270) 461-0430
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN061421
GA
Other
Enumeration date
05/23/2008
Last updated
05/22/2023
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