Provider Demographics
NPI:1912231358
Name:HENDRIX-RAYFIELD, GLENDA J (NP)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:J
Last Name:HENDRIX-RAYFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 MOUNT PLEASANT S
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2379
Mailing Address - Country:US
Mailing Address - Phone:662-571-1236
Mailing Address - Fax:
Practice Address - Street 1:153A S MARKET ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3029
Practice Address - Country:US
Practice Address - Phone:662-252-9987
Practice Address - Fax:662-252-7517
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2009002558OtherANCC
MS0427334Medicaid
MS2009002558OtherANCC