Provider Demographics
NPI:1629594890
Name:HENRY, RHONDA R
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 ET POOLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-4078
Mailing Address - Country:US
Mailing Address - Phone:601-365-9076
Mailing Address - Fax:601-403-9009
Practice Address - Street 1:159 ET POOLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-4078
Practice Address - Country:US
Practice Address - Phone:601-365-9076
Practice Address - Fax:601-403-9009
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6963253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care