Healthcare Provider Details

I. General information

NPI: 1639717713
Provider Name (Legal Business Name): CRAIG DAMON HENRY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 HOSPITAL DR
JACKSON MS
39204-3410
US

IV. Provider business mailing address

837 CRESTON DR
BYRAM MS
39272-3003
US

V. Phone/Fax

Practice location:
  • Phone: 601-346-4586
  • Fax: 601-346-4587
Mailing address:
  • Phone: 601-613-5681
  • Fax: 601-372-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number903338
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number903338
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number903338
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number903338
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number903338
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number903338
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number903338
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number903338
License Number StateMS
# 9
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number903338
License Number StateMS
# 10
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number903338
License Number StateMS
# 11
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903338
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: