Tykerria Renee Henderson
Nurse Practitioner, Family in Vicksburg, MS. Individual provider (NPI-1).
NPI number1104775865
StatusActive
Last updated in NPPESSep 30, 2026
Details
- NPI
- 1104775865
- Entity type
- Individual (NPI-1)
- Name
- Tykerria Renee Henderson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 26, 2026
- Certification date
- Sep 30, 2026
- Last updated
- Sep 30, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 908689 | MS | Yes |
Practice location
3317 Pemberton Square BlvdVicksburg, MS 39180-5578
Phone 601-636-1173
Mailing address
3317 Pemberton Square BlvdVicksburg, MS 39180-5578
Phone 601-636-1173
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All 46 Family Nurse Practitioner providers in Vicksburg · All 1,002 providers in Vicksburg
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