Healthcare Provider Details

I. General information

NPI: 1194705608
Provider Name (Legal Business Name): JENNIFER HENSON O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7865 TRINITY RD STE 104
CORDOVA TN
38018-2274
US

IV. Provider business mailing address

1990 BROOKS BLUFF CV
COLLIERVILLE TN
38017-0854
US

V. Phone/Fax

Practice location:
  • Phone: 901-753-7100
  • Fax: 901-753-3688
Mailing address:
  • Phone: 757-469-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: