DR. LARRY A HENDERSON JR. (NPI# 1215976022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215976022 |
| Entity Type | Individual |
| Full Name | DR. LARRY A HENDERSON JR. |
| Credential | MD |
| Practice Address |
92 Ratliff St Lucedale MS 39452-6537 |
| Mailing Address |
Po Box 1007 Lucedale MS 39452-1007 |
| Practice Telephone | 6019478181 |
| Practice Fax Number | 6019474411 |
| Mailing Telephone | 6019478181 |
| Mailing Fax Number | 6019474411 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-12-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 19697 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09435313 | 05 | |
| FL | 270736500 | 05 | |
| AL | UNITED HEALTH CARE | 01-01886 | 01 |
| AL | 009966685 | 05 | |
| MS | PALMETTO GBA | P00696992 | 01 |
| AL | BLUE CROSS | 51523926 | 01 |
| LA | 1502324 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710399084 | Larry Henderson | Early Intervention Provider Agency | 5100 Obannon Dr Apt 78, Las Vegas, NV 89146 | 2014-05-21 |
| 1699105643 | Larry Henderson | Physician Assistant | 1426 Canyon Ave Ne, Live Oak, FL 32064-4832 | 2013-11-12 |
| 1801019302 | Larry P Henderson | Counselor | 1100 Bob Courtway Dr, Suite 9, Conway, AR 72032-4766 | 2007-04-11 |
| Street Address |
92 RATLIFF ST |
| City | LUCEDALE |
| State | MS |
| Zip Code | 39452-6537 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962960203 | Wilda Parker | Pharmacist | 92 Ratliff St, Lucedale, MS 39452-6537 | 2019-03-05 |
| 1396267308 | Ashley Nicole Eubanks | Pharmacist | 92 Ratliff St, Lucedale, MS 39452-6537 | 2017-07-11 |
| 1205208790 | Community Medical Physicians, PC | Pediatrics | 92 Ratliff St, Lucedale, MS 39452-6537 | 2015-10-23 |
| 1346642428 | Courtney Burns | Registered Nurse | 92 Ratliff St, Lucedale, MS 39452-6537 | 2014-09-21 |
| 1942609664 | Kelley Debar | Registered Nurse | 92 Ratliff St, Lucedale, MS 39452-6537 | 2014-08-19 |
| 1134558315 | Community Urgent Care | Family Medicine | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-11-07 |
| 1841623808 | George County Pharmacy | Pharmacy | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-08-14 |
| 1184961054 | Norman M Parnell | Nurse Practitioner | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-01-11 |
| 1427353283 | Selena Lee Smith | Nurse Practitioner | 92 Ratliff St, Lucedale, MS 39452-6537 | 2011-01-25 |
| 1427363928 | Inpatient Physician Services | Hospitalist | 92 Ratliff St, Lucedale, MS 39452-6537 | 2010-08-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033420609 | Jennifer K. Walker | Massage Therapist | 352 Oak Street, Lucedale, MS 39452 | 2010-06-29 |
| 1780827543 | David J.conner D.d.s. | Dentist | 17215 Hwy 26, Lucedale, MS 39452 | 2009-04-09 |
| 1285873042 | Rebecca Graves | Nurse Practitioner | 92 W Ratliff St, Lucedale, MS 39452 | 2009-02-18 |
| 1639381791 | George County School District | Registered Nurse | Rocky Creek Elementary, 2183 Rocky Creek Road, Lucedale, MS 39452 | 2007-05-03 |
| 1386856425 | George County School District | Registered Nurse | Central Elementary School, 14159 Hwy 26 West, Lucedale, MS 39452 | 2007-05-03 |
| 1730301961 | George County School District | Registered Nurse | Agricola Elementary School, 6165 Hwy 613, Lucedale, MS 39452 | 2007-05-03 |
| 1932311156 | George County School District | Registered Nurse | Lucedale Elementary School, 689 Church Street, Lucedale, MS 39452 | 2007-05-03 |
| 1295947471 | George County School District | Registered Nurse | George County Middle School, 330 Church Street, Lucedale, MS 39452 | 2007-05-03 |
| 1952522583 | David J. Conner | Dentist | 17215 Highway 26 W, Lucedale, MS 39452 | 2007-05-01 |
| 1225258676 | Keith A Brown | Dentist | 16 Plaza Drive, Lucedale, MS 39452 | 2007-04-26 |
| Find all providers in zip 39452 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952854978 | Hieu Nguyen | Family Medicine | 92 Ratliff St # A, Lucedale, MS 39452-6537 | 2016-07-26 |
| 1114187515 | Dayton E. Whites | Family Medicine | 463 Dotty Street, Lucedale, MS 39452-6537 | 2008-06-10 |
| 1285747089 | Eugene Kevin O'hea | Family Medicine | 697 Manila St, Lucedale, MS 39452-6505 | 2006-08-16 |
| 1972616779 | Rollie Demetrius Steele | Family Medicine | 92 W. Ratliff Street, Lucedale, MS 39452-6537 | 2006-08-16 |
| 1770552259 | William Frank Mcarthur | Family Medicine | 859 Winter St, Lucedale, MS 39452-6603 | 2006-03-16 |
| 1831687953 | E Kevin Ohea Md General Family Practice LLC | Family Medicine | 697 Manila St, Lucedale, MS 39452-6505 | 2018-04-24 |
| 1184136962 | Eugene Kevin O'hea | Family Medicine | 697 Manila St, Lucedale, MS 39452-6505 | 2017-11-01 |
| 1114389541 | Jo'el Cheri Welch | Family Medicine | 859 Winter St, Lucedale, MS 39452-6603 | 2016-03-24 |
| 1982023149 | Christopher Shane Blomberg | Family Medicine | 859 Winter St, Lucedale, MS 39452-6603 | 2014-04-15 |
| 1134558315 | Community Urgent Care | Family Medicine | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-11-07 |
| Find all providers in LUCEDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.