Healthcare Provider Details

I. General information

NPI: 1609911072
Provider Name (Legal Business Name): HENDERSON CO HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 RUSH ST
LEXINGTON TN
38351-2241
US

IV. Provider business mailing address

90 RUSH ST
LEXINGTON TN
38351-2241
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-8148
  • Fax: 731-968-4777
Mailing address:
  • Phone: 731-968-8148
  • Fax: 731-968-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000080304
License Number StateTN

VIII. Authorized Official

Name: GINA G WOOD
Title or Position: R.N. #3 SUPERVISOR
Credential: R.N.
Phone: 731-968-8148