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General NPI Number Information
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NPI Number | 1972647519
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Entity Type | Individual
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Provider Name | KENYA HENDERSON OD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 2600 MCINGVALE RD
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City | HERNANDO
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State | MS
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Zip | 38632-8658
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Country | US
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Telephone | 662-429-7099
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Fax | 662-449-3021
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Provider Business Mailing Address
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Address Line | 2600 MCINGVALE RD
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City | HERNANDO
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State | MS
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Zip | 38632-8658
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Country | US
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Telephone | 662-429-7099
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Fax | 662-449-3021
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2618
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 741
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License Number State | MS
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