Healthcare Provider Details

I. General information

NPI: 1184310823
Provider Name (Legal Business Name): ALLISON KAE HENNESSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 AMOKA DR
DIAMONDHEAD MS
39525-4047
US

IV. Provider business mailing address

8316 AMOKA DR
DIAMONDHEAD MS
39525-4047
US

V. Phone/Fax

Practice location:
  • Phone: 228-216-3298
  • Fax:
Mailing address:
  • Phone: 228-216-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1241009
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number917437
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11043151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: