Healthcare Provider Details

I. General information

NPI: 1225975089
Provider Name (Legal Business Name): DEJUNA LATRICE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 DUNCAN WILLIAMS RD
MEMPHIS TN
38119-8112
US

IV. Provider business mailing address

3316 DUNCAN WILLIAMS RD
MEMPHIS TN
38119-8112
US

V. Phone/Fax

Practice location:
  • Phone: 901-406-9383
  • Fax: 901-406-9383
Mailing address:
  • Phone: 901-406-9383
  • Fax: 901-406-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6076
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: