| NPI | 1598560906 |
|---|---|
| Doing Business As | CHAQUITA HENDERSON |
| Entity Type | Organization |
| Authorized Contact | CHAQUITA HENDERSON Nurse Practitioner 601-434-0960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-02-18 |
| Last Update Date | 2025-02-18 |