Provider Demographics
NPI:1780791673
Name:HENDRIX, MARY ANNE (CFNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:VARDAMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38878-0237
Mailing Address - Country:US
Mailing Address - Phone:662-682-7555
Mailing Address - Fax:662-682-7388
Practice Address - Street 1:310 W SWEET POTATO ST
Practice Address - Street 2:
Practice Address - City:VARDAMAN
Practice Address - State:MS
Practice Address - Zip Code:38878-8405
Practice Address - Country:US
Practice Address - Phone:662-682-7555
Practice Address - Fax:662-682-7388
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR665754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120774Medicaid
MS00120774Medicaid