MEDICARE: CRAIG DAMON HENRY MSN, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1600X	Continuing Education/Staff Development Registered Nurse	903338	MS
2	163WH1000X	Hospice Registered Nurse	903338	MS
3	163WI0500X	Infusion Therapy Registered Nurse	903338	MS
4	163WN1003X	Nutrition Support Registered Nurse	903338	MS
5	163WW0000X	Wound Care Registered Nurse	903338	MS
6	163WX0200X	Oncology Registered Nurse	903338	MS
7	207X00000X	Orthopaedic Surgery Physician	903338	MS
8	207XS0117X	Orthopaedic Surgery of the Spine Physician	903338	MS
9	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	903338	MS
10	363LP0200X	Pediatric Nurse Practitioner	903338	MS
11	363LF0000X	Family Nurse Practitioner	903338	MS

General Provider Information

NPI Number	:	1639717713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG DAMON HENRY MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	837 CRESTON DR
Second Line	:
City	:	BYRAM
State	:	MS
Zip	:	39272-3003
Country	:	US
Telephone Number	:	601-613-5681
Fax Number	:	601-372-3059

Provider Business Practice Location Address
First Line	:	1824 HOSPITAL DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-3410
Country	:	US
Telephone Number	:	601-346-4586
Fax Number	:	601-346-4587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	12/19/2019

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