Active NPI
Tykerria Renee Henderson
- Geriatric Medicine (Family Medicine) Physician
- Port Gibson, MS
National Provider Identifier
1104775865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 922851
- Practice address
- 30 Pinehurst St
Port Gibson, MS 39150-2850 - Phone
- (931) 278-9365
- NPI assigned
- Jan 26, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 922851 | MS | Primary |
Addresses
Primary practice location
30 Pinehurst St
Port Gibson, MS 39150-2850
Mailing address
30 Pinehurst St
Port Gibson, MS 39150-2850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 922851 | MS | MD | Geriatric Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1769385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769385600000",
"number": "1104775865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 PINEHURST ST",
"city": "PORT GIBSON",
"state": "MS",
"postal_code": "391502850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 PINEHURST ST",
"city": "PORT GIBSON",
"state": "MS",
"postal_code": "391502850",
"telephone_number": "931-278-9365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "TYKERRIA",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-01-26",
"last_updated": "2026-01-26",
"certification_date": "2026-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MS",
"license": "922851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Gibson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.