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General NPI Number Information
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NPI Number | 1093605255
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Entity Type | Individual
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Provider Name | JACQUELINE ROSEMARIE HENDERSON RN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 812 GREENWOOD AVE
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City | CLARKSVILLE
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State | TN
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Zip | 37040-4068
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Country | US
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Telephone | 877-467-3123
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Fax |
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Provider Business Mailing Address
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Address Line | 343 DUGGER DR
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City | CLARKSVILLE
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State | TN
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Zip | 37042-2988
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Country | US
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Telephone | 910-624-5414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 260791
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License Number State | TN
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