Jessica Henderson-Gray, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

290786-1 Issued in NY

Practice address

735 Walker Ave
Bellport, NY 11713

Phone

(631) 703-6489

NPI assigned

Nov 15, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Henderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480723200000",
    "number": "1730621210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 WALKER AVE",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "11713",
            "telephone_number": "631-703-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 WALKER AVE",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "11713",
            "telephone_number": "631-703-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON-GRAY",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "290786-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HENDERSON",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carlos Ruben Gutierrez, LCSW
• Addie Hampton, CASAC LMHC CRC LPN
• Stephanie Hannigan, SLP
• Tempest Harvey, LPN
• Derek Hawkins, LCSW
• Emily Hennin
• La'Chelle R Henry, LPN
• Annette Holmes, L.P.N.
• Barbara Homan, LPN
• Shannon Sue Honce, LMSW

• Licensed Practical Nurse in Bellport, NY
• Providers in Bellport, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2016; 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.