Individual provider · Type 1 NPI
Tykerria Renee Henderson
Family Nurse Practitioner · Vicksburg, MS
NPI number
1104775865
Active
Practice location
3317 Pemberton Square Blvd
Vicksburg, MS 39180-5578
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 908689 (MS) |
Family Nurse Practitioner: Definition to come...
3 other providers at this address
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About NPI 1104775865
Tykerria Renee Henderson's National Provider Identifier is 1104775865, issued on Jan 26, 2026. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Vicksburg, MS. The record was last updated on Sep 30, 2026.