Gwendolyn K. Herndon, C.R.N.P.

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R643653 Issued in MS

Practice address

400 Hospital Rd
Starkville, MS 39759-2163

Phone

(662) 615-2503

Fax

(662) 615-2554

NPI assigned

Dec 11, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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.

• Och Regional Health Clinic

  • Rural Health Clinic/Center
  • Starkville, MS
  • NPI 1902102692
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1891855623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HOSPITAL RD",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397592163",
            "telephone_number": "662-615-2503",
            "fax_number": "662-615-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HOSPITAL RD",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397592163",
            "telephone_number": "662-615-2503",
            "fax_number": "662-615-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "GWENDOLYN",
        "middle_name": "K.",
        "name_prefix": "Mrs.",
        "credential": "C.R.N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R643653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00112980",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Martin Heflin, RDN
• Henderson Ward Stewart Elementary
• Rosaland Ann Henderson
• Tiffany Henderson
• Arwakee Henley
• Barry William Herring, DMD
• Christopher Herring, OD
• Danley Herring
• Ryakko Quchelle Hickman
• Edward C. High, RRT, AE-C

• Acute Care Nurse Practitioner in Starkville, MS
• Providers in Starkville, MS by specialty
• Acute Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.