Henson Medical Clinic, Inc.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R518328 Issued in MS

Legal business name

HENSON MEDICAL CLINIC, INC.

Doing business as

Urgent Care -- Long Beach

Practice address

200 W Railroad St
104
Long Beach, MS 39560-4517

Phone

(228) 864-0622

Fax

(228) 864-7958

NPI assigned

May 6, 2009

Last updated

May 6, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Wanda F. Henson, FNP-BC

Title

Executive Director

Phone

(228) 864-0622

Specialties & licenses 2

Addresses

Other names 1

• Urgent Care -- Long Beach Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1336373240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395600609",
            "telephone_number": "228-864-0622",
            "fax_number": "228-864-7958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W RAILROAD ST",
            "address_2": "104",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604517",
            "telephone_number": "228-864-0622",
            "fax_number": "228-864-7958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENSON MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "HENSON",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "228-864-0622",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R518328",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R862256",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urgent Care -- Long Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.