Mary Anne Hendrix, CFNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R665754 Issued in MS

Practice address

310 W Sweet Potato St
Vardaman, MS 38878-8405

Phone

(662) 682-7555

Fax

(662) 682-7388

NPI assigned

Aug 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Health Corp of Houston, Inc.

  dba Family Medical Clinic of Okolona

  • Rural Health Clinic/Center
  • Okolona, MS
  • NPI 1134236870
  NPD (past)

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1780791673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 237",
            "city": "VARDAMAN",
            "state": "MS",
            "postal_code": "388780237",
            "telephone_number": "662-682-7555",
            "fax_number": "662-682-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W SWEET POTATO ST",
            "city": "VARDAMAN",
            "state": "MS",
            "postal_code": "388788405",
            "telephone_number": "662-682-7555",
            "fax_number": "662-682-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRIX",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R665754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120774",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Altheacare LLC (Family Medical Clinic Vardaman)
• Barry Dayton Criddle, R.PH.
• Freds Stores of Tennessee Inc (Freds Xpress 3926)
• William Eldon Hester, RPH
• Cheryll Angel Ray, RPH
• SCPG Mississippi LLC (Express Rx of Vardaman)
• Laquania Williams, NURSE PRACTITIONER

• Nurse Practitioner in Vardaman, MS
• Providers in Vardaman, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.