Provider Demographics
NPI:1619354420
Name:HENDRY, ASHLEE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:LYNN
Last Name:HENDRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 EVELYN GANDY PKWY
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-3947
Mailing Address - Country:US
Mailing Address - Phone:601-584-4309
Mailing Address - Fax:601-584-4890
Practice Address - Street 1:1146 EVELYN GANDY PKWY
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-3947
Practice Address - Country:US
Practice Address - Phone:601-584-4309
Practice Address - Fax:601-584-4890
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3173207Q00000X
MS27968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS27968OtherMS MEDICAL LICENSE
TNQ035602Medicaid