Provider Demographics
NPI:1083227060
Name:HENDERSON, JESSICA LYNN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13327 WISDOM WAY
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1513
Mailing Address - Country:US
Mailing Address - Phone:240-970-7300
Mailing Address - Fax:240-231-9755
Practice Address - Street 1:13327 WISDOM WAY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1513
Practice Address - Country:US
Practice Address - Phone:240-970-7300
Practice Address - Fax:240-231-9755
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health