Provider Demographics
NPI:1114364353
Name:THE HEADACHE CENTER, PLLC
Entity Type:Organization
Organization Name:THE HEADACHE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREPPENDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-366-0855
Mailing Address - Street 1:1000 HIGHLAND COLONY PKWY
Mailing Address - Street 2:SUITE 7205
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2073
Mailing Address - Country:US
Mailing Address - Phone:601-366-0855
Mailing Address - Fax:601-898-9833
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE 7205
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:601-366-0855
Practice Address - Fax:601-898-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858785208VP0014X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty