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General NPI Number Information
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NPI Number | 1134944226
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Entity Type | Individual
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Provider Name | LAURA JEAN HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 311 LANDRUM PL STE 500C
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6319
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Country | US
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Telephone | 931-272-2446
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Fax | 931-266-0528
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Provider Business Mailing Address
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Address Line | 311 LANDRUM PL STE 500C
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6319
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Country | US
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Telephone | 931-272-2446
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Fax | 931-266-0528
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 37795
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License Number State | TN
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